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.

Keywords: Colon cancer; Complication; Elderly; Lymph node dissection.

© 2025. The Author(s).

背景: D3淋巴结清扫（LND）对结肠癌（CC）的肿瘤学影响已被报道为有利。然而，D3 LND可能比非D3 LND更具侵入性，对于老年结肠癌患者是否有益尚不清楚。本研究旨在评估D3 LND在老年结肠癌患者的围手术期安全性以及短期和长期肿瘤学结局。

方法: 受试者为2011年至2022年间接受病理分期（pStage）I-III CC根治性手术的442名70岁及以上老年患者。研究对比了D3 LND组（D3组，n = 363）和非D3 LND组（非D3组，n = 79）患者的背景临床因素以及短期和长期结局。

结果: 与非D3组相比，D3组的取回淋巴结数量显著更多（中位数20 vs. 12, p

结论: D3 LND在改善病理分期II/III期老年结肠癌患者的预后方面是安全且有效的。

关键词: 结肠癌；并发症；老年人；淋巴结清扫。