Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 580–587 | Cite as

Impact of Total Lymph Node Count on Staging and Survival After Neoadjuvant Chemoradiation Therapy for Rectal Cancer

  • Matthew D. Hall
  • Timothy E. Schultheiss
  • David D. Smith
  • Marwan G. Fakih
  • Joseph Kim
  • Jeffrey Y. C. Wong
  • Yi-Jen Chen
Colorectal Cancer



Current guidelines recommend that a minimum of 12 lymph nodes (LNs) be dissected to accurately stage rectal cancer patients. Neoadjuvant chemoradiation therapy (CRT) decreases the number of LNs retrieved at surgery. The purpose of this study was to assess the impact of the number of LNs dissected on overall survival (OS) for localized rectal cancer patients treated with neoadjuvant CRT.


Treatment data were obtained on all patients treated for rectal cancer (2000–2013) in the National Oncology Data Alliance™, a proprietary database of merged tumor registries. Eligible patients were treated with neoadjuvant CRT followed by surgery and had complete data on number of positive LNs, number of LNs examined, and treatment dates (n = 4565).


Hazard ratios for OS decreased sequentially with increasing number of LNs examined until a maximum benefit was achieved with examination of eight LNs. On multivariate analysis, age, sex, race, marital status, grade, ypT stage, ypN stage, type of surgery, margin status, presence of pathologically confirmed metastasis at surgery, and number of LNs examined were significant predictors of OS.


Examination of eight or more LNs in rectal cancer patients treated with neoadjuvant CRT resulted in accurate staging and assignment into prognostic groups with an ensuing improvement in OS by stage. This study suggests that eight LNs is the threshold for an adequate lymph node dissection after neoadjuvant CRT.


Overall Survival Rectal Cancer Total Mesorectal Excision National Comprehensive Cancer Network Rectal Cancer Patient 





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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Matthew D. Hall
    • 1
  • Timothy E. Schultheiss
    • 1
  • David D. Smith
    • 2
  • Marwan G. Fakih
    • 3
  • Joseph Kim
    • 4
  • Jeffrey Y. C. Wong
    • 1
  • Yi-Jen Chen
    • 1
  1. 1.Department of Radiation OncologyCity of Hope National Medical CancerDuarteUSA
  2. 2.Division of BiostatisticsCity of Hope National Medical CancerDuarteUSA
  3. 3.Department of Medical Oncology and Therapeutics ResearchCity of Hope National Medical CancerDuarteUSA
  4. 4.Department of SurgeryCity of Hope National Medical CancerDuarteUSA

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