Ogura A, et al. - Given that a significant proportion of patients with rectal cancer with enlarged lateral lymph nodes (LLNs) suffer from lateral local recurrence (LR) [LLR] even in the face of total mesorectal excision (TME) and negative resection margins (R0), researchers investigated if LLNs actually posed a problem and if LLN dissection (LLND) resulted in fewer LLRs in this multicenter pooled analysis including 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who had surgery in a 5-year period. A total of 142 patients (12%) had LLND. LLN features were evaluated by re-assessing magnetic resonance imagings (MRIs) with a standardized protocol. They noted a visible LLN in 703 patients (58%) on pretreatment MRI, and 192 (16%) had a short axis of at least 7 mm. LR was seen in 108 patients, of which LLRs were 59 (54%). A remarkably higher risk of LLR was observed for LLNs with a short axis of at least 7 mm vs LLNs of less than 7 mm following multivariable analyses. A 5-year LLR of 5.7% was seen with (chemo)radiotherapy ([C]RT) plus TME plus LLND in patients with LLNs at least 7 mm, which was remarkably lower than that in patients who underwent (C)RT plus TME.