As mentioned earlier, there are a number of variables that contribute to the overall lymph node count in colorectal cancer specimens. We acknowledge the ease and perceived objectivity associated with using lymph node counts as a measure of specimen adequacy. However, we agree with multiple authors who have cautioned against using lymph node number Inhibitors,research,lifescience,medical as a measure of quality. In conclusion, we believe that the current CAP recommendation of 12-15 lymph nodes examined in a colorectal specimen is appropriate. Our

calculations suggest sampling 12-15 lymph nodes will yield a roughly 80% selleck products negative predictive value (NPV) for metastasis of colorectal carcinoma. There has been an increase in the use of multiple tools for better screening and earlier detection of colorectal carcinoma, which may improve the ability to detect cancers at an earlier stage. This will likely

be augmented Inhibitors,research,lifescience,medical through education regarding the importance of screening and increase in access to appropriate medical care and diagnoses. There are a number Inhibitors,research,lifescience,medical of variables that dictate the number of lymph nodes retrieved in any given specimen. Therefore, even though lymph node counts provide a single, objective data point, the value these numbers yield remains unclear. The truest indicator of quality care remains the patient’s outcome. Acknowledgements Disclosure: The authors declare no conflict of interest.

With a 5-year survival rate of only 5%, pancreatic cancer

is the fourth leading cause of cancer-related death in the United States (1). Neoadjuvant therapy is increasingly utilized for patients with Inhibitors,research,lifescience,medical pancreatic cancer with the goal of decreasing tumor burden in anticipation of later surgical resection (2,3). The intent is that, by local control and/or tumor down-staging with therapy, there will be a resultant survival benefit, which recent data has confirmed (4). The majority Inhibitors,research,lifescience,medical of patients are treated with a combination of gemcitabine, 5-FU and platinum compounds along with radiation therapy (5). Although the pool of patients who are candidates for neoadjuvant Sitaxentan therapy has been estimated to be only 4.5% of the overall number diagnosed with pancreatic cancer (3), this represents an important population for whom there is an opportunity to prolong survival and increase quality of life. Chemotherapy in patients with obstructing pancreatic cancers requires stenting to relieve the biliary obstruction, as many chemotherapeutic agents require functioning bilirubin transport mechanisms and bile excretion to avoid toxicity (6). Stent occlusion in these high-risk patients can lead to life-threatening complications. Metal stents have larger diameters than plastic stents, and therefore are less susceptible to occlusion.