[Methogs & Subjects] A total of 225 cases of advanced lower rectal cancer with the pathologic depth of tumor invasion of A or deeper treated by curative resection from 1990 to 2007 were enrolloed in this study examining correlations between clinicopathological features and therapeutic outcomes. [Results] The enrolled patients were 183 who underwent lateral lymph node dissection {LLD (+) group} and the remaining 42 who did not {LLD (-) group}. There were no significant differences in background factors between both groups. The rate of recurrence to the lateral lymph nodes in the LLD (+) group was 9.8% versus 14.3% in the LLD (-) group, without significant difference. A multivariate analysis of overall survivals resulted in that an independent poor prognostic factor was to omit LLD. The postoperative recurrence rate in patients with lateral lymph node metastasis was as high as 70.7% and the hematogenic metastatic rate in them was also high, 43.9%, with a significant difference. The five-year survival rate in those with lateral lymph node metastasis was as low as 29.0% versus 69.2% in those without lateral lymph node metastasis, and the overall survival rate in the former group was also significantly poor compared with the other. [Considerations] This study suggests a possibility that LLD for advanced lower rectal cancer patients can improve the prognosis compared with those without LLD. However, patients with lateral lymph node metastasis experienced postoperative metastasis in a high rate and had extremely poor prognosis, so that postoperative multi-modal therapy including radiochemotherapy should be considered to improve the therapeutic outcomes.