In reply
Population-based studies, institutional reviews, and prospective randomized controlled trials have all demonstrated low lymph node counts after colectomy for cancer. This is the reality of what is happening in the United States and around the world. Patients often have an inadequate number of lymph nodes resected and examined.1 Thus, the bigger message is that if the surgical community believes that resections of fewer than 12 nodes (or some established benchmark, as the relationship between node counts and survival is continuous) are inadequate, then we need to work harder to cooperate with our pathologists to ensure that this benchmark is met. It is encouraging that lymph node counts after colectomy are increasing in the United States,2 but there is still room for improvement.