Correspondence - Is the optimal examined lymph node number for rectal cancer altered - Editor Letter

Sep 21, 2026

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Editorial correspondence assessing whether the optimal examined lymph node (ELN) number in rectal cancer (RC) affects long-term outcomes. It reviews evidence linking higher ELN counts to more accurate nodal staging and improved survival, notes a suggested cutoff of 15 ELNs, and proposes improvements. The letter critiques limitations, including lack of surgical quality assessment and unaccounted prognostic factors such as resection margin, tumor location, and EMVI, concluding further research is required to define the optimal ELN number for survival.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Key points on ELN count and prognosis

Surgical approach and quality assessment

Limitations of SEER variables and missing prognostic factors

Conclusion and need for further research

’Correspondence Is the optimal examined lymph node number for rectal cancer altered? Xiaoyan Li, MD, Ke Hu, MD* Dear Editor, Surgery is the primary treatment for rectal cancer (RC), and it remains the cornerstone of curative intent. The examination of lymph nodes is an essential aspect of radical surgery for RC and directly reﬂects the quality of the procedure. Many studies have demonstrated a signiﬁcant association between the count of examined lymph nodes (ELNs) and the prognosis of RC. To ensure an adequate resection, the American Joint Committee for Cancer guidelines recommend the examination of a minimum of 12 lymph nodes in colorectal cancer specimens. However, Guan et al. [1] analyzed the correlation between ELN count and overall survival (OS) in RC by using the Surveillance, Epidemiology, and End Results (SEER) database and a Chinese multi-institutional registry. They discovered that a higher ELN count is related to more accurate nodal staging and improved survival in RC. The optimal cut-off point for assessing the quality of lymph node examination and prognosis stratiﬁcation is 15 ELNs. While the authors have acknowledged the limitations in the ‘Discussion’section, we have provided insightful recommendations for additional improvement. Firstly, a variety of surgical approaches, depending on the location and extent of the disease, are used to treat primary RC lesions. In cases of T1N0 RC, local resection can be a viable treatment option following careful screening. However, for the majority of RCs, a standardized approach to radical surgery is recommended. Total mesorectal excision (TME) has been shown to yield favorable outcomes and is therefore considered a best practice[2] . Ample evidence exists to support that the quality of RC resection is crucial and affects local recurrence and survival. The prognosis of patients undergoing surgical treatment isinﬂuenced by the performance of standard radical surgery. So if this study is to establish a quantitative correlation between the count of ELN and the long-term survival in RC, it is imperative to Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China Sponsorships or competing interests that maybe relevant to content are disclosed atthe end of this article. *Corresponding author. Address: Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, People ’s Republic of China. Tel.: + [86 010 6915 4015. E-mail: huke8000@126.com](86 010 6915 4015. E-mail: huke8000@126.com) (K. Hu). Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. International Journal of Surgery (2024) 110:4526–4527 Received 21 March 2024; Accepted 24 March 2024 Published online 9 April 2024 [http://dx.doi.org/10.1097/JS9.0000000000001427](http://dx.doi.org/10.1097/JS9.0000000000001427) critically assess whether the patients underwent standard radical surgery. However, the study did not include an assessment of the quality of surgery in the patients. This may lead to a distortion of the true correlation between the number of ELN and survival. Secondly, to bolster the reliability of the ﬁndings, the researchers made efforts to account for potential variables that could impact the results. Nonetheless, given the constraints of the SEER database, there remain some critical prognostic factors that were not taken into account, such as resection margin, tumor location, and extramural vascular invasion (EMVI)[3] . The study’s ﬁndings are somewhat hindered

FAQs

Why is the examined lymph node (ELN) count important in rectal cancer?

ELN count is tied to the quality of radical surgery and reflects nodal staging accuracy, which correlates with rectal cancer prognosis.

What cutoff ELN number is discussed as optimal?

The correspondence cites evidence that 15 ELNs is the optimal cutoff for quality assessment and prognostic stratification.

What limitations does the letter highlight in the referenced study?

It notes that surgical quality was not assessed and that SEER-based analyses may omit key prognostic factors such as resection margin, tumor location, and extramural vascular invasion (EMVI).

What conclusion does the correspondence reach?

The authors acknowledge the retrospective study efforts but argue that further research is necessary to confirm the optimal ELN number for long-term survival.

Sep 21, 2026

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