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To determine the lymph node positive rate after a complete clinical response following neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC).A 4 year (2004-2008), retrospective review of all patients referred to the clinical oncology department of St. Bartholomew Hospital from the four hospitals of the North East London Cancer Network was undertaken to identify patients with rectal cancer. Patients with LARC were identified from the radiology and colorectal MDT databases and were cross referenced with the oncology database. Pathological staging identified patients with node positive disease.One hundred and thirty-six patients with LARC had nCRT, following resection with curative intent. 26 (19%) patients had a complete biological response (ypT0N0), three (2.2%) patients had nodal disease with a complete tumour response (ypT0N1). Within the subgroup of patients with complete tumour response (ypT0 = 29), there was a 10% incidence of nodal diseaseTen percent of LARC patients with a complete tumour response following nCRT had nodal disease and may suggest a significant risk of local recurrence if a ‘watch and wait’ policy is followed after an apparent complete clinical response.