Laparoscopic lymphatic mapping and sentinel lymph node detection in colon cancer: technical aspects and preliminary results

Background: The utility of lymph node mapping to improve staging in colon cancer is under evaluation. Laparoscopic colectomy for colon cancer has been validated in multicentric trials. This study assessed the feasibility of lymph node mapping in laparoscopic colectomy for colon cancer. Methods: From March 2004 to December 2005, 22 patients were studied. Before resection, 2 to 3 ml of Patent Blue V dye was injected subserosally around the tumor. Colored lymph nodes were marked as sentinel nodes (SNs) with metal clips, and laparoscopic colectomy with lymphadenectomy was completed as normal. In SNs, multiple 4-mu m slices at 50-mu m intervals were stained with hematoxylin and eosin and examined. Anticytokeratin antibody immunostaining was applied in doubtful cases. Other lymph nodes were examined with multiple slices at 100-to 500-mu m intervals by standard methods. Results: The SN detection rate was 100%, although ex vivo lymph node mapping was necessary for an obese patient. Five patients (22.7%) were SN positive. There was one false-negative SN (16.7%). In two cases (9.1%) with aberrant lymphatic drainage, lymphadenectomy was extended. The SN reflected the status of the regional lymph nodes in 21 patients (95.4%). Accuracy was 95.4%, and negative predictive value was 94.1%. Conclusions: Laparoscopic lymphatic mapping and SN removal is feasible in laparoscopic colectomy for colon cancer. Although the false-negative rate was high (16.7%), the overall results are promising and justify prospective studies to determine the real accuracy and false-negative rate for the technique.