Surgeons should prioritize examining at least 7 lymph nodes in rectal cancer patients post-neoadjuvant therapy to optimize outcomes.

• Examining fewer than 7 lymph nodes results in a 5-year disease-free survival rate of 65.1%, compared to 76.3% with 7 or more (p=0.03).
• In the SEER cohort, patients with fewer than 7 lymph nodes have a 5-year cancer-specific survival rate of 79.1%, versus 83.0% for those with 7 or more (p=0.04).

Adapting the current guideline of examining ≥12 lymph nodes may enhance patient outcomes following neoadjuvant treatment.