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Omission of Adjuvant Chemotherapy or Inadequate Surgery?

To the Editor—We read with great interest the article entitled “Omission of Adjuvant Chemotherapy Is Associated With Increased Mortality in Patients With T3N0 Colon Cancer With Inadequate Lymph Node Harvest.” Although the results of the study were impressive, we feel that there are some points that must be clarified. First of all, the authors did not fully elucidate their surgical technique. If they performed total mesocolic excision (TME) and retrieved a suboptimal number of lymph nodes and thus added chemotherapy, then their surgery and overall management should be considered inadequate. If they did not perform TME, then their surgical management is questionable from the beginning, depending on the latest findings and superior outcomes about TME in colon cancer. It may also be worthwhile to say that reaching clearcut conclusions based on such a wide database (ie, National Cancer Database) that involves a wide variety of clinical approaches might be erroneous. This is especially true for surgical techniques that cannot be standardized in large databases.