Although there is still controversy between the East and the West on lateral lymph node dissection of rectal cancer, Chinese academia has formulated the consensus, guidelines, and norms of lateral lymph node dissection in line with China's national conditions based on the existing evidence-based medicine. Compared with Japan, the lateral lymph node dissection indication in China is more strict, and only when there is clear imaging evidence suspected of lateral metastatic lymph nodes will selective dissection be carried out. The routine dissection area is also limited to the internal ilium and around the obturator. Based on a comprehensive understanding of the anatomical structure of the pelvis, fascia-guided clearance of the two spaces has become the mainstream scheme of lateral lymph node dissection in China. This operation has obvious advantages in clear lymph node dissection boundary, protection of nerve function, complete removal of lateral lymph nodes, and so on. In the future, with the progress of more high-quality lateral lymph node dissection studies, there will be more evidence to regulate the clinical application of lateral lymph node dissection for rectal cancer.