D3 lymph node dissection improves perioperative outcomes and overall survival in patients with cT2N0 colorectal cancer.

The extent of lymphadenectomy undertaken in patients with cT2N0 colorectal cancer (CRC) remains controversial. The aim of our study was to compare survival in such patients by level of lymph node dissection (LND) performed. This retrospective cohort study was conducted at a high-volume cancer center in Japan. Eligible patients (n=524) submitted to radical resections for cT2N0 CRC between April 2007 and December 2020 were included. Subjects were subsequently stratified by nature of LND (D2 vs. D3) and propensity score matched at 1:2 ratio. We then analyzed group rates of overall survival (OS) and relapse-free survival (RFS) before and after matching. Before matching, the D3 (vs. D2) LND group experienced a shorter mean operative time, less intraoperative blood loss, fewer postoperative complications, and a briefer average hospital stay, showing significantly better OS (P=0.001) as well. The estimated hazard ratio (HR) was 2.0 [95% confidence interval (CI): 1.0-3.9; P=0.04]. After matching, a significant difference in OS (P=0.007) was still observed, with an estimated HR of 2.3 (95% CI: 1.0-5.1; P=0.044). D3 LND improves perioperative outcomes and OS in patients with cT2N0 CRC. Accurate preoperative imaging diagnostics are critical for proper surgical management for cT2N0 CRC.