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Clinical staging and LPLN evaluation Pretreatment clinical stage was assessed based on multidetector CT (MDCT) and/or MRI. Tumor location was determined by endoscopy, barium enema and transrectal ultrasound, and LN enlargement was determined by MDCT and/or MRI. All the images were retrospectively reviewed by one colorectal surgeon and two experienced radiologists, who were blinded to the precise clinical information. The maximum long and short axis diameter of the LPLNs were measured before and after the preoperative CRT (i.e., just before rectal surgery), and LPLN positivity was defined as any lymph node sized >7 mm in Verteporfin in vivo the long-axis diameter in the lateral pelvic area, according to previous reports (9,10). Reduction of LPLN size following preoperative CRT was defined as initially positive LPLN downsized to Vandetanib research buy (5-FU)-based chemotherapy, including 5-FU/leucovorin, tegafur/uracil and S-1 (12,13). Long-course CRT was mainly used for patients with low-lying tumors and intended sphincter preservation, or tumors close to the circumferential margin. The mean interval between the completion of CRT and TME was 10 days in short-course and 6�C8 weeks in long-course CRT. LPLN dissection was not introduced in this study, with the exception of staging biopsy in 1 patient. Clinical response and tumor regression after CRT The degree of histopathological tumor regression was defined based on the Guidelines for the Clinical and Pathological Studies on Carcinoma of the Colorectum, and was classified into 4 grades: Grade 0, no necrosis or regressive change; grade 1a, 66% vital residual tumor cells (VRTCs); grade Itraconazole 1b, ~33�C66% VRTCs; grade 2,