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

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.

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).

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).

D3 LND is safe and effective in improving the prognosis of elderly patients with pStage II/III CC.