Lateral lymph node metastasis (LLNM) is common in mid-low rectal cancer and is also a major cause of postoperative local recurrence. Currently, there is still controversy regarding the diagnosis and treatment of LLNM in rectal cancer. This consensus, based on the "Chinese Consensus on Diagnosis and Treatment of Lateral Lymph Node Metastasis in Rectal Cancer (2019 edition)," incorporates the latest domestic and international research findings and revises aspects related to the diagnosis, treatment strategies, follow-up, and management of recurrence of LLNM in rectal cancer. A total of 42 domestic colorectal cancer experts participated in this consensus. It proposes 18 consensus statements on the diagnosis and treatment of LLNM, using the evaluation criteria of the U.S. Preventive Services Task Force for grading recommendations. The aim is to standardize further the diagnostic criteria and treatment strategies for LLNM in rectal cancer. Unresolved issues in this consensus require further clinical practice and active engagement in high-quality clinical research to explore and address them progressively.