Background: worldwide, colorectal cancer is the third most commonly occurring cancer in men and the second most commonly occurring cancer in women. There were over 1.8 million new cases in 2018. Objective: evaluation of lateral pelvic lymph node involvement among patients with middle and low rectal carcinoma. Patients and Methods: a descriptive prospective study was conducted at Surgical Unit of Oncology Bab Elshaarya University Hospital, Al Azhar University, during the period between November 2018 and July 2019 (a total period of 8 months), in which 20 patients of middle and low rectal carcinoma were identified. Results: all patients had rectal adenocarcinoma; 17 patients (85%) with grade 2 and 3 patients (15%) with grade 3. Of the 20 identified patients, 15 patients (75%) had vascular invasion and 5 patients (25%) had no vascular invasion. Only 4 patients (20%) had positive lateral pelvic lymph nodes and 11 patients (55%) had positive mesorectal lymph nodes. All patients with positive lateral pelvic lymph nodes had also positive mesorectal lymph nodes. Conclusion: total Mesorectal Excision (T.M.E.) is a standard operation for rectal carcinoma due to high incidence of mesorectal lymph node metastases. Transanal total mesorectal excision (TaTME) is a promising technique in rectal surgery especially in low rectal cancers. Most of patients had positive mesorectal lymph nodes and all patients with positive lateral pelvic lymph nodes also had positive mesorectal lymph nodes.