How Many Nodes Have to Be Detected/Examined After Preoperative Radio(chemo) Therapy?

  • David Tan
  • Iris D. Nagtegaal
  • Rob Glynne-Jones


In patients with colonic and rectal cancer treated with surgery alone, prognosis depends primarily on the pathological stage of the tumour according to the tumour, node, metastasis (TNM) system, based on the extent of the primary tumour (pT) and its relationship to the muscularis propria, the absence or extent of nodal involvement (pN), the number of the involved regional lymph nodes (pN1 vs. pN2) and the presence or absence of distant metastases (M). It remains uncertain, how best to interpret histopathology for patients with rectal cancer after chemoradiation (CRT) or short-course preoperative radiotherapy (SCPRT). Early histopathological endpoints are dependent on many patient and treatment factors. The number of lymph nodes reported may reflect factors such as quality of TME surgery, whether a high tie was performed, the radiation dose and field size, the type and dose of chemotherapy used, the diligence of the pathologist in processing the specimen and finding lymph nodes, the timing of surgery following CRT or SCPRT and possibly also the route by which these changes were achieved, i.e. chemotherapy, chemoradiation or radiotherapy alone. In this chapter, we will discuss how many nodes are required to be detected and examined after preoperative radio(chemo)therapy to give an accurate prognosis and how increased numbers may be detected in the histopathological specimen.


Rectal cancer Preoperative chemoradiotherapy Lymph node status Lymph node ratio Prognosis 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  • David Tan
    • 1
  • Iris D. Nagtegaal
    • 2
  • Rob Glynne-Jones
    • 3
  1. 1.Department of Radiation OncologyNational Cancer Centre, SingaporeSingaporeSingapore
  2. 2.Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
  3. 3.Mount Vernon Centre for Cancer TreatmentNorthwoodUK

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