Incidence of lateral pelvic lymph node involvement has been reported between 10-25%. It is thought that lower rectal tumours are more likely to spread to the lateral pelvic nodes. In the far East, LPLN dissection is often added to the TME procedure. Formal LPLND is not utilised in Europe due to operative risks including damage to pelvic nerves, greater blood loss and prolonged operating time. Instead, neoadjuvant chemoradiotherapy (CRT) is utilised to 'sterilise' the lymph nodes. Although a retrospective analysis suggested that LPLN dissection is equivalent to preoperative CRT for preventing local recurrence, there has been evidence to suggest that positive LPLNs after CRT decrease cancer specific survival and relapse free survival. This would suggest that there may be a cohort of patients that would benefit from some form of LPLN dissection, although it is not certain what characteristics of tumours are more likely to metastasise to the LPLNs.