Lateral pelvic lymph nodes in rectal cancer: a narrative review

Lateral pelvic lymph node (LPLN) involvement represents a critical determinant of oncologic outcomes in rectal cancer, directly influencing the risks of local recurrence, distant metastasis, and overall survival. High-resolution rectal magnetic resonance imaging (MRI) is the modality of choice for both initial staging and post-treatment restaging. A comprehensive approach integrating nodal size, morphology and primary tumor characteristics and treatment response is indicated for accurate evaluation. The optimal management of LPLNs differs between Eastern and Western practices, although a convergence toward selective, risk-adapted strategies is increasingly recognized. Familiarity with the imaging anatomy of the lateral pelvis and current high-risk criteria are essential for radiologists involved in the multidisciplinary care of rectal cancer patients.