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This study was designed to examine the feasibility of performing a non-mesorectal sentinel lymph node biopsy for low-to-mid rectal cancers using Technetium (99 m-Tc) and Patent Blue.Twenty patients undergoing elective resection for rectal cancer were included. One millilitre (80 MBq) of radiolabelled 99 m-Tc and 1 ml of Patent Blue dye were injected submucosally into or around the tumour. Standard TME was performed. Using a hand heldprobe, non-mesorectal lymph nodes with radioactivity and/or blue stained were removed.All patients (n = 20) had radioactive nodes within the mesorectum. Seven non-mesorectal sentinel lymph nodes were identified in five patients (identification rate = 25%). None of the identified sentinel nodes were positive for malignancy. The sites of non-mesorectal lymphatic drainage were: para-aortic (four nodes), obturator (two nodes) andpresacral (one node) basins. The identification rate was greater for: (1) those who did not receive radiotherapy (50%), (2) low rectal lesions (33%) (3) early T stage (30%) tumours. The identification rate was not related to mesorectal nodal status, size of the tumour, CEA level or degree of differentiation.The mapping of non-mesorectal lymph node for rectal cancer is feasible, in particular in the non-radiated pelvis and early stage tumours lying below the peritoneal reflection.