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Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The clinical significance of D3 lymph node dissection for patients with colon cancer remains controversial. This study aims to clarify the impact of D3 lymph node dissection on survival in patients with colon cancer.

Methods

This is a retrospective cohort study from a prospectively registered multi-institutional database of colorectal cancer in Japan. Propensity score matching method was applied to balance potential confounders of the treatment. A cohort of 10,098 patients who underwent radical colectomy for pT3 and pT4 colon cancer between 1985 and 1994 were identified. A total of 3,425 propensity score matched pairs were extracted from the entire cohort. The primary outcome measure was overall survival (OS).

Results

In the entire cohort, there was a statistically significant difference in overall survival (OS) between the patients who had D3 and D2 lymph node dissection (p = 0.00003). The estimated hazard ratio (HR) for OS of patients who had D3 versus D2 lymph node dissection was 0.827 (95 % confidence interval, 0.757 to 0.904). In the matched cohort, there was also a significant difference in OS between the two groups (p = 0.0001), and the estimated HR for OS was 0.814 (95 % confidence interval, 0.734 to 0.904).

Conclusions

We found D3 lymph node dissection for pT3 and pT4 colon cancer to be associated with a significant survival advantage in a large-scale database, even after adjusting potential confounders of lymph node dissection. This finding may provide a rationale for D3 lymph node dissection in radical surgery for pT3 and pT4 colon cancer.

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Ethical statement

This study was exempted from review by the Tochigi Cancer Center’s institutional review board, because it used pre-existing data with no personal identifiers.

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan

    Kenjiro Kotake, Tomoka Mizuguchi, Konosuke Moritani, Osamu Wada & Heita Ozawa

  2. Epidemiology Unit, Tochigi Cancer Center Research Institute, Utsunomiya, Japan

    Izumi Oki

  3. Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Kenichi Sugihara

Authors
  1. Kenjiro Kotake
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  2. Tomoka Mizuguchi
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  3. Konosuke Moritani
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  4. Osamu Wada
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  5. Heita Ozawa
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  6. Izumi Oki
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  7. Kenichi Sugihara
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Corresponding author

Correspondence to Kenjiro Kotake.

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Kotake, K., Mizuguchi, T., Moritani, K. et al. Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer. Int J Colorectal Dis 29, 847–852 (2014). https://doi.org/10.1007/s00384-014-1885-z

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  • DOI: https://doi.org/10.1007/s00384-014-1885-z

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