To compare the short-term and medium-term outcomes of neoadjuvant chemoradiotherapy（nCRT）followed by open and laparoscopic lateral lymph node dissection（LPLND）.

The clinicopathologic data of 139 patients with rectal cancer who underwent total mesenterectomy（TME）+LPLND after nCRT in two hospitals from January 2010 to June 2022 were retrospectively collected and analyzed. The patients were divided into laparoscopy group and laparotomy group according to the surgical approach. Propensity score matching method was used to match the covariables 1：1，and finally 16 patients were included in the laparoscopy group and the laparotomy group respectively. t test or χ² test were used to compare the surgical results，postoperative complications and pathological results between the two groups. Kaplan-Meier method was used to draw the survival curve，the Long-Rank method was used to compare the survival time，and the significant factors were included in the COX proportional risk regression model for multivariate prognostic analysis.　 P<0.05 was considered statistically significant.

And when we match，In the laparoscopic group，postoperative blood loss was decreased（100 vs. 300 ml，P=0.017），postoperative hospital stay was shortened（7 vs. 15 d，P=0.011），the number of LPLN dissection（9 vs. 7，P=0.003）and total lymph node dissection（25 vs. 20，P=0.033）increased significantly. In terms of survival prognosis，there was no significant difference in 3-year overall survival rate（92.3% vs. 75.2%，P=0.929）and tumor-free survival rate（71.3% vs. 63.6%，P=0.976）between the laparoscopic and open groups.

Laparoscopic LPLND after nCRT is safe and feasible，with short term advantages such as less trauma，quick recovery and thorough lymph node dissection. At the same time，it has a similar medium-term oncology outcome to open LPLND.