Feasibility of laparoscopic sentinel basin dissection for limited resection in early gastric cancer

Background: The clinical applications of sentinel node (SN) biopsies in early gastric cancer are limited because of low sensitivity. Sentinel basin (SB) dissection has been suggested as alternative to SN biopsy to improve sensitivity. The aim of this study was to examine the feasibility of laparoscopic SB dissection. Methods: Twenty-one gastric adenocarcinoma patients of cTIN0 were enrolled. Technetium 99 in human serum albumin and indocyanine green were injected into the submucosal layer around tumor using an intraoperative endoscope. Green-stained or radioactive lymphatic basins were detected and defined as SBs. After laparoscopic SB dissection, laparoscopy-assisted gastrectomy with D2 lymphadenectomy was performed. Dissected SB nodes and non-SB nodes were evaluated for metastasis pathologically. Results: The SB detection rate was 95.2%. Numbers of SBs were one in 6, two in 10, and three in 4 patients. The mean number of SB nodes was 7.0. Two patients with lymph node metastasis were diagnosed by SB dissection. Mean time of laparoscopic SB dissection procedure was 15.2 min. Conclusions: Above findings suggest that laparoscopic SB dissection is technically feasible, and it might have better sensitivity than SN biopsy. However, the validity of this procedure should be evaluated in a larger series before being clinically applied.