Lateral pelvic lymph node dissection (LPND) is a technically challenging procedure, and the safety and feasibility of laparoscopic LPND remains undetermined. We compared the short- and long-term survival outcomes of laparoscopic LPND with those of open LPND.From January 2012 to December 2019, locally advanced middle-low rectal cancer patients with clinical evidence of lateral pelvic lymph node metastasis (LPNM) who underwent total mesorectal excision with LPND at three institutions were included. Propensity score matching was used to minimize selection bias. The short-term and oncological outcomes of open and laparoscopic LPND were compared.Overall, 384 patients were enrolled, including 277 and 107 patients who underwent laparoscopic and open LPND, respectively. After matching, patients were stratified into laparoscopic (n = 100) and open (n = 100) LPND groups. Patients in the laparoscopic LPND group had a shorter operation time (255 vs. 300 min, P=0.001), less intraoperative blood loss (50 vs. 300 mL, P<0.001), lower incidence of postoperative complications (32.0% vs. 15.0%, P=0.005), shorter postoperative hospital stay (8 vs. 14 days, P<0.001), and excision of more lateral pelvic lymph nodes (9 vs. 7, P=0.025) than those in the open LPND group. The 3-year overall survival (P=0.581) and 3-year disease-free survival (P=0.745) rates were similar between the groups, and LPNM was an independent predictor of survival.Laparoscopic LPND is technically safe and feasible with favourable short-term results and similar oncological outcomes as open surgery in selected patients.This article is protected by copyright. All rights reserved.