We thank Kjetil Søreide and coauthors for their interesting comments. It is important to confirm our results, as they are reported in another recent publication, using another statistical analysis. Whatever the analysis, the association between a particular tumor pathway, MSI, and a specific number of isolated lymph nodes are of major interest as outlined by Berho and Wexner.1
This observation is about surgery, but is not just for surgeons or pathologists. Surgery is a key component of public health systems around the world, specifically for cancer care. Colon cancer is the most common gastrointestinal malignancy and the second-leading cause of death in the United States.2 The need to improve quality, innovation, and evaluation in surgery has been considered major objectives.3 In that triad of interest, many efforts have been made in the last 10 years around evaluation.4 Nodal involvement is an important factor predicting long-term survival in digestive tract cancer. Numerous studies have shown an improvement in disease-specific and overall survival when elevated numbers of lymph nodes are reported for colon cancer.4 It was intriguing that most authors associated this high number with quality of care and not with a specific reaction to the tumor.