Extended D3 lymph node dissection (LND) is often indicated for relatively young colorectal cancer patients as a mean to improve disease-free survival. However, in older patients the role of extended LND is not clear.

A retrospective analysis of consecutive patients ≥75 years old, stage II-III colon cancer who had radical resection in one of two institutions. In one center all patients had D2 LND, in another - D3 LND according to institution policy. Eighty-eight patients 75-79 years old (group 1- 42 right colectomies and 46 left colectomies) were compared with 132 patients aged ≥80 years (group 2- 76 right colectomies and 56 left colectomies).

Group 2 patients had significantly higher initial Charlson Comorbidity Index than group 1 patients (7 and 6, p = 0.02). Procedure
length, blood loss, postoperative inhospital stay didn’t differ significantly neither between groups, nor between right and left
colectomies, nor D2 and D3 LND. In group 1, 5-year OS was significantly higher after D3 LND than after D2 LND (87% and 58%, p = 0.002) as well as 5-year cancer-specific survival (84% and 54%, p = 0.002). In group 2, no survival benefit was demonstrated in D3 over D2 LND. Moreover, compared with D2 LND, patients after D3 LND had longer postoperative ventilation and higher grade 3 and 4 postoperative morbidity.

D3 LND can be indicated in older patients 75-79 y.o. as it improves 5-year overall and recurrence-free survival. In patients over 80 y.o., D3 LND leads to higher postoperative morbidity and doesn’t influence oncologic outcomes.