# Safety and feasibility of D3 lymph node dissection in oldest-old patients undergoing colorectal cancer surgery: a multi-institutional, retrospective analysis

## TL;DR

This study shows that extensive lymph node dissection is safe for patients aged 90+ undergoing colorectal cancer surgery without increasing complications or hospital stays.

## Contribution

The study provides the first multi-institutional evidence on the safety of D3 lymph node dissection in the oldest-old CRC population.

## Key findings

- D3 LND resulted in significantly higher lymph node harvests for both Stage II and III patients.
- No significant differences in postoperative complications were found between D3 and non-D3 groups.
- Hospital stays were shorter for Stage III patients undergoing D3 LND.

## Abstract

Colorectal cancer (CRC) is a significant health burden, with lymph node dissection (LND) playing a critical role in staging and guiding treatment. However, the optimal extent of LND for the oldest-old population (aged ≥ 90 years) remains undefined because of insufficient targeted clinical data. This study aimed to compare the short-term outcomes of D3 versus non-D3 LND in Stage II–III CRC in oldest-old patients.

This retrospective cohort study utilized data from the Setouchi Colorectal Neoplasm Registration database, including 282 oldest-old patients with CRC treated between 2011 and 2022. Patients were stratified into D3 and non-D3 LND groups, with inverse-probability-weighted regression adjustment implemented to address potential confounding factors. Postoperative complications and hospital stays were analyzed using regression models and descriptive statistics.

D3 LND resulted in significantly higher lymph node harvests in both Stage II and Stage III patients (p < 0.01). There were no significant differences in overall or major postoperative complications between D3 and non-D3 groups. Hospital stays were comparable for Stage II patients but shorter for Stage III patients in the D3 group (p < 0.01). Complication rates ranged from 28% to 47.7%, with surgical site infections and pneumonia being the most common.

D3 LND can be safely performed in oldest-old patients with CRC without increasing postoperative complications or extending hospital stays. These findings support the feasibility of extensive LND in this age group, but further studies are needed to evaluate its oncological benefits.

The online version contains supplementary material available at 10.1007/s10151-025-03187-3.