Impact of D3 lymph node dissection on short-term and long-term outcomes in elderly patients with colon cancer

• Published in: Techniques in coloproctology Vol. 29; no. 1; p. 107
• Main Authors: Kawase, M., Nakamura, Y., Yamaura, T., Kinjo, Y., Sugimoto, G., Kawabata, Y., Kanto, S., Ogo, Y., Kuroda, N.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2025; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Aged, 80 and over; Colonic Neoplasms - mortality; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Colorectal cancer; Colorectal Surgery; Female; Gastroenterology; Humans; Lymph Node Excision - adverse effects; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Lymphatic system; Male; Medical prognosis; Medicine; Medicine & Public Health; Neoplasm Staging; Original; Original Article; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctology; Retrospective Studies; Surgery; Time Factors; Treatment Outcome; Complication; Colon cancer; Lymph node dissection; Elderly
• ISSN: 1123-6337; 1128-045X; 1128-045X
• DOI: 10.1007/s10151-025-03149-9

Background The oncologic impact of D3 lymph node dissection (LND) for colon cancer (CC) has been reported to be favorable. However, D3 LND is potentially more invasive than non-D3 LND, and whether it is beneficial for elderly patients with CC remains unclear. This study aimed to evaluate the perioperative safety and short- and long-term oncologic outcomes of D3 LND in elderly patients with CC. Methods Subjects were 442 elderly patients aged ≥ 70 years who underwent curative surgery for pathologic stage (pStage) I−III CC between 2011 and 2022. Background clinical factors and short- and long-term outcomes were compared between patients who received D3 LND (D3 group; n  = 363) and those who received non-D3 LND (non-D3 group; n  = 79). Results The D3 group had a significantly higher number of retrieved lymph nodes (median 20 vs. 12, p  < 0.001) and a lower rate of postoperative complications (18% vs. 32%, p  = 0.040) than the non-D3 group. In the overall cohort, overall survival (OS) did not differ between the two groups. Among pStage III patients, however, OS was significantly better (69.8% vs. 34.1%, p  = 0.028), and RFS tended to be better (60.7% vs. 42.6%, p  = 0.075) in the D3 group than in the non-D3 group. Multivariable analysis revealed that D3 LND was independently associated with better OS (HR 0.477; 95% CI 0.245–0.931, p  = 0.030) and tended to be associated with better RFS (HR 0.588; 95% CI 0.329–1.051, p  = 0.073). Conclusion D3 LND is safe and effective in improving the prognosis of elderly patients with pStage II/III CC.