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

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2025-05-05 DOI:10.1007/s10151-025-03149-9

M Kawase, Y Nakamura, T Yamaura, Y Kinjo, G Sugimoto, Y Kawabata, S Kanto, Y Ogo, N Kuroda

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引用次数: 0

Abstract

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.

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D3淋巴结清扫对老年结肠癌患者近期和远期预后的影响。

背景：据报道，D3淋巴结清扫术（LND）对结肠癌（CC）的肿瘤学影响是有利的。然而，D3 LND可能比非D3 LND更具侵袭性，是否对老年CC患者有益仍不清楚。本研究旨在评估老年CC患者D3 LND的围手术期安全性和短期和长期肿瘤预后。方法：研究对象为442例年龄≥70岁，2011年至2022年间接受病理分期（pStage） I-III期CC根治性手术的老年患者。比较接受D3 LND患者的临床背景因素和短期和长期结局(D3组；n = 363)和接受非d3 LND的患者(非d3组；N = 79)。结果：与非D3组相比，D3组的淋巴结清扫数明显增加（中位数20比12，p < 0.001），术后并发症发生率明显降低（18%比32%，p = 0.040）。在整个队列中，两组之间的总生存期（OS）没有差异。然而，在piii期患者中，D3组的OS明显优于非D3组（69.8% vs. 34.1%, p = 0.028）， RFS倾向于更好（60.7% vs. 42.6%, p = 0.075）。多变量分析显示，D3 LND与较好的OS独立相关(HR 0.477；95% CI 0.245-0.931, p = 0.030)，并倾向于与较好的RFS相关(HR 0.588；95% CI 0.329-1.051, p = 0.073)。结论：D3 LND在改善老年pii /III期CC患者预后方面安全有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.