Abstract Background Lateral nodal disease is ofmajor importance in the treatment of rectal cancer in theEast, but a mostly neglected entity in the West. In this article, the treatment of recurrences in the lateral compartment (latLRs) in a national tertiary referral centre is evaluated. Methods Of 214 patients with locally recurrent rectal cancer who underwent multimodality treatment in the Catharina Hospital in the last 10 years, a total of 51 patients with latLR were selected (the latLR region was classified as upper, middle, or lower). Thirteen (25 percent) of these patients underwent induction chemotherapy (ICT) prior to chemo(re) irradiation. Results LatLRs occurredmainly after lowandN+primary tumours. Seven (14 percent) patients had a complete response (pCR) and 28 (55 percent) underwent anR0 resection. Patients with a lower latLRhad the highest chance of undergoing an abdominoperineal resection and resection of anterior organs. ICT resulted in a 31 percent pCR rate compared with 8 percent without ICT (P = 0.039). Patients who received ICT had an 85 percent R0 resection rate, while this was 45 percent in patients who did not receive ICT (P = 0.013). The 5-year local re-recurrence (LRR) rate was 64.3 percent, and overall survival (OS) was 34.2 percent; the only factor improving these was an R0 resection. Five-year survival after multivariate analyses was 10.3 percent after an R+ resection compared with 66.8 percent after an R0 resection (P = 0.011). Conclusions LatLRs impose a major surgical challenge and result in high LRR and low OS. More R0 resections can possibly be achieved with ICT, which is the only factor that can improve LRR and OS.