Background: Performing a laparoscopic-assisted dissection of the pelvic lymph node in low advanced cancer rectum patients is a complicated surgical procedure with a high liability of surgical morbidity. Its safety needed further clarification. Objective: This study aims to compare the open pelvic lymph nodes dissection and the laparoscopic-assisted approach in the low advanced rectal cancer patients with clinically suspected nodal metastases in the term of safety, technical feasibility, and patient's oncological outcomes. Patients and methods: Sixty patients of low advanced cancer rectum had reviewed. (30 cases) were underwent laparoscopic total mesorectal excision. The other 30 patients had operated by open procedure) in addition to lateral pelvic dissection. Results: The duration of operation in the laparoscopically assisted procedure was longer than the open one(p=0.003). The postoperative hospital stay was longer in the open group than in the laparoscopic group (P=0.043). No significant differences between both groups regarding the number of excised lymph nodes, disease recurrence, RFS, or OS rate. Conclusions: performing laparoscopic total mesorectal resection in addition to excision of the lateral pelvic lymph nodes is technically easy with less morbidity, accurate dissection, and faster recovery than the open approach in addition to comparable oncological results and similar patient survival.