Ogura A, Konishi T, Beets GL, et al. - Through a multicenter pooled cohort study involving 741 patients with low rectal cancer following chemoradiotherapy or radiotherapy, researchers ascertained the factors on primary and restaging MRI that were correlated with lateral local recurrence (LLR) in low rectal cancer following chemoradiotherapy or radiotherapy ([C]RT) and formulated particular guidelines on which patients might profit from a lateral lymph node dissection (LLND). A SA lateral node size of 7 mm or greater on primary MRI led to a 5-year LLR rate of 17.9% following (C)RT with total mesorectal excision (TME). At 3 years, no LLRs in 28 patients with lateral nodes that were 4 mm or less on restaging MRI were noted. In comparison with nodes in the obturator compartment of that size, nodes that were 7 mm or greater on primary MRI and greater than 4 mm on restaging MRI in the internal iliac compartment led to a 5-year LLR rate of 52.3%, significantly higher. On the contrary with (C)RT with TME alone, treatment with (C)RT with TME and LLND in these unresponsive internal nodes led to a significantly weaker LLR rate of 8.7%. Hence, in lateral nodal disease, restaging MRI is significant in clinical decision making. In patients with shrinkage of lateral nodes from a SA node size of 7 mm or greater on primary MRI to a SA node size of 4 mm or less on restaging MRI, which transpires in about 30% of cases, LLND could be circumvented. Nevertheless, persistently enlarged nodes in the internal iliac compartment symbolize a remarkably great risk of LLR, and an LLND reduced LLR in these cases.