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Prognosis of rectal cancer patients depends on the number of harvested nodes. Harvest depends on quality of surgery, pathology and patient factors. Aim was to evaluate whether there are differencesin number & size of mesorectal lymph nodes (MRL) between patients with and without rectal cancer, which could influence nodal harvest.Size & number of MRL in 71 rectal cancer patients and in 30 control patients were measured on high-resolution pelvic-MRI. The control patients had disease not affecting MRL. These measurements were compared between both groups and in sub-groups.Mean 16 ± 9 MRL were found per patient in the controls versus 21 ± 12 MRL in rectal cancer patients (P = 0.019). Mean size in the controls was 1.6 ± 0.8 mm vs 2.8 ± 1.5 mm in rectal cancer patients (P < 0.0001).Number & size of MRL did not differ between the pN+ and pN0 rectal cancer patients: 21 ± 10 nodes/patient (pN+) vs 22 ± 13 nodes/patient (pN0) (P = 0.61), size was 3.2 ± 1.8 (pN+) vs 2.5 ± 1.3 (pN0), P = 0.07. Number & size of rectal cancer patients with pN0 differed significantly from that of the controls: P = 0.026 (number) and P = 0.001 (size).Number & size of MRL is significantly higher in rectal cancer patients than in controls. These results support the literature that there might be an immune response to rectal cancer, leading to an increased number and size of nodes.