Abstract Background: The role of lateral pelvic lymph node dis-section (LPLD) in the treatment of rectal cancer is still controversial. This study examines the outcomes and possible benefits of adding LPLD to the gold standard surgery for rectal cancer: Total mesorectal excision (TME). Aim of Study: Compare the outcomes of adding LPLD to TME vs TME alone for management of rectal cancer in terms of recurrence, survival, and complications. Patients and Methods: A systematic review and meta-analysis comparing outcomes of TME + LPLD versus TME alone in over 6000 patients. Studied outcomes are recurrence, survival, and complications. Results: 18 studies were included comparing outcomes in 2762 patients treated by TME+LPLD versus 3371 patients treated by TME alone for low rectal cancer. Outcomes com-pared are overall survival (OR: 1.02), 5-year overall survival (OR: 1.01), disease free survival (OR: 1.07), 5-year disease free survival (OR: 1.07), local recurrence (OR: 1.01), distant recurrence (OR: 0.96), total recurrence (OR: 0.97), postoper-ative complications (OR: 1.59), urinary dysfunction (OR: 6.66), sexual dysfunction (OR: 9.67), and operative time (mean difference: 116.02). Conclusion: Adding LPLD to TME for rectal cancer treatment is associated with higher rates of complications and longer operative time, with no added value regarding recurrence or survival when compared with TME alone as a treatment modality.