Background: The utility of lymphnode mapping to improve staging in colon cancer is still under evaluation. Laparoscopic colectomy for colon cancer has been validated in multicentric trials. This study assessed the feasibility and technical aspects of lymphnode mapping in laparoscopic colectomy for colon cancer. Methods. Forty-two patients with histologically proven colon cancer were studied from January 2006 to September 2007. Exclusion criteria were: advanced disease (clinical stage III), rectal cancer, previous colon resection and contraindication to laparoscopy. Lymphnodal status was assessed preoperatively by computed tomography (CT) scan and intraoperatively with the aid of laparoscopic ultrasound. Before resection, 2-3 ml of Patent Blue V dye was injected subserosally around the tumor. Colored lymphnodes were marked as sentinel (SN) with metal clips or suture and laparoscopic colectomy with lymphadenectomy completed as normal. In case of failure of the intraoperative procedure an ex vivo SN biopsy was performed on the colectomy specimen after resection. Results. A total number of 904 lymphnodes were examined, with a median number of 22 lymphnodes harvested per patient. The SN detection rate was 100%, an ex vivo lymphnode mapping was necessary in 4 patients. Eleven (26.2%) patients had lymphnodal metastases and in 5 (45.5%) of these patients, SN was the only positive lymphnode. There were two (18.2%) false negative SN. In three cases (7.1%) with aberrant lymphatic drainage, lymphadenectomy was extended. The accuracy of SN mapping was 95.2% and negative predictive value was 93.9%. Conclusions: Laparoscopic lymphatic mapping and SN removal is feasible in laparoscopic colectomy for colon cancer. The ex vivo technique is useful as salvage technique in case of failure of the intraoperative procedure. Prospective studies are justified to determine the real accuracy and false negative rate of the technique.

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