Purpose:  Exact lymph  node  staging is essential  for prognosis  estimation  and  treatment stratification in rectal cancer. Recent  studies showed that ex-vivo injection of methylene  blue dye into the inferior mesenteric artery of rectal cancer specimens might improve lymph node harvest. This study evaluates pathological lymph node assessment using this recent technique compared to conventional pathological techniques. Methods:Methylene  blue solution was injected ex-vivo into the inferior mesenteric artery of 25 rectal cancer specimens and lymph node assessment was performed after formaline fixing overnight. The results were compared to data obtained from a control group of25 rectal cancer specimens which underwent conventional pathological lymph node assessment. Results: Methylene  blue injection was successfully performed in all patients in the stained group. A total number of 383 (15.32 ±4.28) and 157 (6.28 ±2.79) lymph nodes were detected in the stained and unstained groups respectively (p < 0.001). The difference was most pronounced in lymph nodes measuring -:!:_4  mm in diameter (p < 0.001). Metastases  were found in 154 (6.16 ±6.76) and 37(1.48 ± 2.86)  lymph nodes occurring in 18 and 10 patients in the stained and unstained  groups, respectively  (p=  0.003). Lymph node ratio (LNR) was calculated  for the patients who were finally staged as stage III showing no significant difference between the two groups. Conclusions: Ex-vivo  methylene  blue injection  into  the  inferior  mesenteric  artery  is  a simple, easy and safe method that significantly improves lymph node harvesting in rectal cancer, especially small-sized lymph nodes