Rectal cancer constitutes a major public health issue according to their incidence and the number of deaths per year. Total mesorectal excision have been considered as the gold standard treatment since 1990s for mid and low rectal tumors. However, when cancer spreads to lateral lymph nodes located along the iliac and obturator arteries, Western and Japanese guidelines differ: whereas Western surgeons consider it as an advanced disease and uses neoadjuvant radiochemotherapy, Japanese surgeons define it as a local disease and proceed to lateral lymph node dissection. Herein, we review the current literature regarding both therapeutic strategies, looking for potential improvements for patients with rectal cancer.