Complete response in primary tissue cancer with a residual tumor in the lymph nodes (ypT0N+) is a possible pathologic finding in rectal cancer resected specimens analyzed after neoadjuvant therapy. The purpose of this study was to examine the survival of ypT0N+ patients with rectal cancer who underwent neoadjuvant therapy followed by surgery and to compare their outcomes to those of patients in other pathologic categories over a 5-year period. Researchers looked back and saw how things went. The National Cancer Database served as their primary resource. Patients with rectal adenocarcinoma were identified who received either complete neoadjuvant therapy or neoadjuvant chemoradiation followed by surgery between 2006 and 2016. In total, 5 pathologic subtypes were distinguished in addition to ypT0N+: ypT1-2N0, ypT3-4N0, ypT1-2N+, and ypT3-4N+. Specifically, overall survival at 5 years was the primary endpoint. Rectal adenocarcinoma patients numbered 30,751. There were 342 people diagnosed with ypT0N+, and 181 (or 52.9% of the total) were given complete neoadjuvant treatment. For patients who underwent comprehensive neoadjuvant treatment, ypT0N+ status was associated with a shorter 5-year overall survival compared to ypT0N0 and ypT1-2N0 statuses. But compared to ypT3-4N+, overall survival at 5 years was better for those with ypT0N+ disease. Neither ypT0N+ nor ypT3-4N0 nor ypT1-2N+ had better 5-year overall survival than the other subtypes. Patients who were given both neoadjuvant chemoradiation and adjuvant chemotherapy showed similar results. Patients with ypT0N+ had a shorter overall survival if they were older, male, and/or had more positive lymph nodes. This study has several caveats, including its retrospective design, a lack of variables detailing the chemotherapy and radiation regimens used, and a dearth of data regarding disease-specific survival or recurrence. Overall survival was shorter in those who developed ypT0N+ compared to those who developed ypT0N0 or ypT1-2N0. However, compared to ypT3-4N+, it was linked to a better 5-year overall survival.