Short- and long-term outcomes of laparoscopic right hemicolectomy with D3 resection for right colon cancer in elderly patients.

Abstract

Background: Laparoscopic right hemicolectomy (RHC) with D3 resection, similar to complete mesocolic excision, is an oncologically satisfying procedure; however, it remains controversial in elderly patients. There are no reports of the procedure for tumors fed by middle colic vessels because it is a difficult procedure. We evaluated the feasibility and oncological outcomes of the procedure in elderly patients.

Methods: We retrospectively evaluated 336 consecutive patients undergoing laparoscopic right hemicolectomy with D3 resection for Stage I-III ascending and transverse colon cancer between 2010 and 2021. Patients were divided into the EP (age ≥ 75 years) and nEP (age < 75 years) groups, and short- and long-term outcomes were analyzed using propensity score matching.

Results: The median follow-up period was 60.7 months. After matching, we enrolled 129 patients. The surgery time, estimated blood loss, postoperative complication rate, number of harvested lymph nodes, and recurrence rate did not differ significantly between the groups; however, the adjuvant chemotherapy rate was significantly lower in the EP group. The EP group had significantly shorter overall survival (OS) (p < 0.01) than the nEP group; however, the cancer-specific (p = 0.15) and recurrence-free (p = 0.36) survivals did not differ significantly from those in the nEP group. In multivariate analyses, age ≥ 75 years, ASA ≥ 3, and pT4 were independent prognostic factors for OS (p = 0.02, < 0.01, < 0.01, respectively); however, only pT4 was an independent prognostic factor for CSS and RFS (p < 0.01 for both).

Conclusions: This procedure offers safe, feasible, and satisfactory oncological outcomes for elderly patients.