Neoadjuvant Chemoradiation for Rectal Cancer Reduces Lymph Node Harvest in Proctectomy Specimens

The purpose of this study was to compare the number of lymph nodes retrieved following proctectomy for rectal cancer in patients either receiving no neoadjuvant therapy versus those treated with standard preoperative chemoradiation. A retrospective review was performed of all consecutive patients that underwent proctectomy for rectal cancer from 1997-2006. Specimens from patients that received neoadjuvant therapy were compared to patients that did not receive preoperative chemoradiation. Of a total of 286 patients, 188 received neoadjuvant therapy and 88 did not. More patients with stage II or higher cancers received neoadjuvant therapy. Overall, fewer neoadjuvant patients underwent an anastomotic procedure than the no neoadjuvant group (17% vs. 7% APR). Significantly fewer total lymph nodes were retrieved in the neoadjuvant therapy patients compared to those who did not receive preoperatively therapy (Neo 14.6 +/- 0.6 vs. No-Neo 17.2 +/- 1.1, p < 0.029). Standard neoadjuvant therapy significantly decreases the number of lymph nodes retrieved following proctectomy for patients with rectal cancers. Quality initiatives or performance measures evaluating lymph node harvest following proctectomy should reflect the use of preoperative chemoradiation.