For T2-T3 N+ rectal patients with large (2+ cm) bilateral sidewall nodes outside the TME volume, should you extend elective nodal volumes anteriorly to include external iliacs?  

No, I would not routinely extend elective nodal volumes anteriorly to include external iliac nodes in a patient with T2-3 N+ disease and large bilateral sidewall nodes outside the TME volume. Lymphatic (and venous) drainage of low and mid rectal cancers includes internal iliac (pelvic sidewall) and ...