OBJECTIVE. The purpose of this article is to discuss the importance of lateral pelvic lymph node metastasis as a predictor of local recurrence and survival in patients with advanced rectal cancer. CONCLUSION. Prediction of lateral pelvic nodal staging on MRI shows high accuracy compared with the other imaging modalities. Diffusion-weighted MRI or (18)F-FDG PET/CT may be helpful to assesses lateral pelvic lymph node metastasis.