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Drs Dawson and Wiebusch and I myself appreciate the interest of Dr Fujita in our study.1 Dr Fujita's comments reference a recently published study confirming that the issue of adequate nodal staging in patients with colorectal cancer in North America is not yet resolved: rates of adequate nodal staging in accredited cancer centers are much higher than those in nonaccredited institutions.2 We agree with his comments that many factors affect lymph node retrieval rates. In our study, we stated that the surgeon, the pathologist, and the patient and/or tumor biology all may influence the numbers of nodes resected and analyzed.
Thirlby RC. Routine or Selective Endoscopic Tattooing in Colon Resection for Cancer—Reply. Arch Surg. 2011;146(2):239-240. doi:10.1001/archsurg.2010.321