Abstract: The lateral pelvic lymph node (LPLN) is a common lymphatic drainage pathway for middle-low rectal cancer. Approximately 14%-30% of patients with locally advanced rectal cancer have LPLN metastasis. However, the omission of a preoperative diagnosis and non-standard treatment cause postoperative LPLN recurrence and may cause difficulties in the diagnosis and treatment of cancer. The value and significance of lateral pelvic lymph node dissection (LPLND) remain controversial in eastern and western countries. In recent years, alternative treatment models of neoadjuvant chemoradiotherapy (nCRT) and LPLND have been integrated, and a set of precise and individualized treatment strategies has been developed. With the development of novel surgical instruments, equipment, and lymph node tracer technology, factors restricting LPLND application have gradually disappeared, resulting in widespread use in clinical practice. However, numerous issues regarding treatment strategies, LPLND indications, prognostic value, effective cleaning range, and safety of LPLND in patients with rectal cancer require further research.