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Extranodal cancer deposits without nodal structure (EXs) occur frequently in advanced rectal cancer. The aim of this study was to examine the impact of EXs in pts who underwent lateral lymph node dissection (LLD) with advanced rectal cancer.A total of 272 pts who underwent curative surgery with LLD for advanced rectal cancer between 1992 and 2004 were reviewed. Metastatic sites were divided into three areas: A area without lateral spread, B area between the inferior pelvic plexus and the internal iliac artery, and C area outside of internal iliac artery.EXs were detected in 44 pts (16%): 37 pts in A area, 6 pts in B area, and 1 pts in C area, respectively. The 5-year disease-free survival rate was 31% in lateral LNM (B + C area) pts and 14% in EXs pts. Multivariate analysis showed significant worseprognosis in EXs, LNM (A area), CA19-9 and lower rectal cancer of an anal canal. Multivariate analysis disclosed that lymphatic invasion, EXs, CA19-9 and non sphincterpreservation surgery were significantly associated with an increased local recurrence.EXs were more importantpredictor than lateral LNM (B and C area) in both survival and local recurrence.