title: What does absence of lymph node in resected specimen mean after neoadjuvant chemoradiation for rectal cancer.
abstract: BACKGROUND
  The effect of insufficient node sampling in patients with rectal cancer managed by neoadjuvant chemoradiation followed by surgery has not been clearly determined. We evalulated the impact of insufficient sampling or even abscence of lymph nodes in the specimen on survival in patients at high-risk (T3, T4 or node positive) for rectal cancer.
  
  
  METHODS
  We conducted a single institution, retrospective analysis of all patients who underwent surgical rectal resection following neoadjuvant chemoradiation for treatment of mid to lower rectal cancer between 1997 and 2009. ypNX was defined as the absence of lymph nodes retrieved in the resected specimen.
  
  
  RESULTS
  A total of 132 patients underwent resection for treatment of rectal cancer following neoadjuvant chemoradiation. Ninety four patients (71.2%) were considered as having node-negative disease, including ypNx and ypN0. In 38 patients (28.8%), the primary tumor was associated with regional lymph node metastases (ypNpos). The mean number of retrieved nodes per specimen was 14.2, respectively. The five-year overall survival from initial operation for the ypNx group was 100%, respectively. The estimated five-year overall survival for ypN0 and ypNpos was 84.0% and 60.3%, respectively (P =0.001). No significant differences in overall survival were observed between the ypNx and ypN0 group (P =0.302).
  
  
  CONCLUSIONS
  Absence of recovered LN in resected specimens after neoadjuvant chemoradiation was observed in 7.6% of specimens. Absence of LN should not be regarded as a risk factor for poor survival or as a sign of less radical surgery.
authors: Department of Surgery, Gil Medical Center, School of Medicine, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea. gsbaek@gilhospital.com.
authors: Won-Suk
authors: WS
authors: Lee
authors: Seok Ho
authors: SH
authors: Lee
authors: Jeong-Heum
authors: JH
authors: Baek
authors: Woon Kee
authors: WK
authors: Lee
authors: Jung Nam
authors: JN
authors: Lee
authors: Na Rae
authors: NR
authors: Kim
authors: Yeon Ho
authors: YH
authors: Park
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy
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