Makoto Takahashi1, Hiroaki Niitsu2, Kazuhiro Sakamoto1, Takao Hinoi2,3, Minoru Hattori2, Michitoshi Goto1, Hiroyuki Bando4, Shoichi Hazama5, Kiyoshi Maeda6, Kenji Okita7, Hisanaga Horie8, Masahiko Watanabe9. 1. Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan. 2. Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 3. Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan. 4. Department of General and Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan. 5. Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Faculty of Medicine and Health Science, Yamaguchi, Japan. 6. Department of Surgical Oncology, Osaka City University Graduate School and Faculty of Medicine, Osaka, Japan. 7. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan. 8. Department of Surgery, Jichi Medical University, Tochigi, Japan. 9. Department of Surgery, Kitasato University, Sagamihara, Japan.
Abstract
INTRODUCTION: In surgery for elderly patients with colorectal cancer, it is unclear whether radical lymph node (LN) dissection safely offers a survival benefit. The aim of the study was to evaluate the impact of the LN yield in elderly patients undergoing surgery for colorectal cancer. METHODS: The subjects were selected from a surgical database of 2065 patients aged ≥80 years old who underwent surgery for colorectal cancer at 41 hospitals in Japan between 2003 and 2007. The patients were divided into groups according to the number LN harvested: <12 and ≥12. Propensity scores were subsequently matched to balance the baseline characteristics. RESULTS: Of the 954 patients initially selected, 331 were in the <12 LN and 623 were in the ≥12 LN group. After cases were matched, 293 patients were allocated to each group, and all covariates were balanced. For short-term outcomes, the time for surgery was longer in the ≥12 LN group, but there was no significant difference in morbidity between the groups. Overall, relapse-free and cancer-specific survival rates were higher in the ≥12 LN group (P = 0.004, 0.001, and 0.02). CONCLUSIONS: In patients aged ≥80 years old with stage II-III colon cancer, harvesting ≥12 LN provides a survival benefit, and therefore, limited LN dissection is not recommended in these patients.
INTRODUCTION: In surgery for elderly patients with colorectal cancer, it is unclear whether radical lymph node (LN) dissection safely offers a survival benefit. The aim of the study was to evaluate the impact of the LN yield in elderly patients undergoing surgery for colorectal cancer. METHODS: The subjects were selected from a surgical database of 2065 patients aged ≥80 years old who underwent surgery for colorectal cancer at 41 hospitals in Japan between 2003 and 2007. The patients were divided into groups according to the number LN harvested: <12 and ≥12. Propensity scores were subsequently matched to balance the baseline characteristics. RESULTS: Of the 954 patients initially selected, 331 were in the <12 LN and 623 were in the ≥12 LN group. After cases were matched, 293 patients were allocated to each group, and all covariates were balanced. For short-term outcomes, the time for surgery was longer in the ≥12 LN group, but there was no significant difference in morbidity between the groups. Overall, relapse-free and cancer-specific survival rates were higher in the ≥12 LN group (P = 0.004, 0.001, and 0.02). CONCLUSIONS: In patients aged ≥80 years old with stage II-III colon cancer, harvesting ≥12 LN provides a survival benefit, and therefore, limited LN dissection is not recommended in these patients.