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To assess the value of extended (lateral) lymphadenectomy (EL) in the operative management of recurrent and locally advancedprimary rectal cancer.Patients undergoing exenterative surgery, between 2006 and 2009, for recurrent or locally advancedprimary rectal cancer were included. Peri-operative outcomes, survival and recurrence rates were assessed and compared between the two groupsprospectively.Forty-three consecutive patients were included (EL = 18, non-EL = 25). The median age was 57 (40-70) for EL and 66 (39-81) years for non-EL. Twenty-eight (EL = 13) patients underwent pelvic exenteration and 15 (EL = 5) abdominosacral resection. Twelve (EL = 7) patients had locally advancedprimary rectal cancer. Thirty-three (EL = 13) patients had neo-adjuvant radiotherapy. The median intra-operative time, blood loss and hospital stay were 9 (3-13) hours, 1.2 (0.3-5) litres and 14 (12-72) days respectively for EL, whereas for non-EL were 8 (3-15) hours, 1.5 (0.25-17) litres and 14 (10-86) respectively (P > 0.380). Complete tumour resection (R0) was achieved in 30 (EL = 13) patients. Local recurrence was diagnosed in four and five patients (P = 0.812) and distant recurrence in three and seven patients (P = 0.411) in the EL and non-EL group respectively. All recurrences occurred within 22 months. There was no significant difference in 3-year survival (HR = 0.36, P = 0.34).This study demonstrated that EL does notprovide a significant oncological advantage, for patients with recurrent or locally advancedprimary rectal cancer.