Background: Resection of a minimum number of lymph nodes (LN) has been considered crucial during radical surgery for the treatment and staging of colorectal cancer. However, distal rectal tumor downstaging as consequence of neoadjuvant chemoradiation therapy (CRT) may lead to primary tumor as well as lymph node sterilization. Therefore, the optimal number of retrieved lymph nodes in this situation and its role in survival has not yet been determined. Patients and Methods: 237 patients with distal rectal cancer, managed by neoadjuvant CRT were retrospectively reviewed. Patients with incomplete tumor response after at least 8 weeks from CRT completion were referred to radical surgery. Patient outcomes were compared according to the total number of lymph nodes retrieved from the resected specimen in patients with N0 tumors. Results: 68 patients had at least one metastatic lymph node after pathological examination. The remaining 169 patients had a mean of 8.8 lymph node/specimen. 76 patients (55%) had ≥9 LN/specimen recovered while 93 patients (45%) had <9 LN/specimen. There were no significant differences in terms of OS (91% vs 93%) and DFS (66% vs 66%) between patients with <9 LN/specimen and ≥9 LN/specimen (p=0.6 and 0.8) for all N0 patients, as well as stage-adjusted (Stage p0-II). These results were also not significant when dividing patients with <3LN/patient and 1LN/patient. Both groups (≥9LN/patient and <9LN/patient) had better OS and DFS rates when compared to patients with stage III disease (p<0.001). Conclusions: Decreased number of lymph node retriveal after radical surgery for N0 distal rectal cancer following neoadjuvant CRT is not a prognostic factor. The presence of at least one LN metastases remains as a significant prognostic factor in these patients. These results support the hypothesis that CRT may lead to sterilization of perirectal lymph nodes and not to understaging due to inadequate sampling