Lateral pelvic lymph node dissection in rectal cancer patients with responsive nodes after neoadjuvant therapy shows no survival benefit, impacting surgical strategies.

• No significant differences in 5-year local recurrence rates (3.1% vs. 5.3%), disease-free survival (77.1% vs. 71.4%), or overall survival (87.0% vs. 86.9%) with or without dissection.
• Dissection led to longer operative times (279.3 vs. 237.9 minutes) and higher early complication rates (27.0% vs. 19.6%).

This suggests focusing on patient selection may reduce surgical morbidity without compromising oncological outcomes.