In recent years, with the continuous development of medical technology and the continuous maturity of precision anastomosis instruments, the willingness of some patients to preserve anus has been realized, but at the same time, it has also increased the incidence of anastomotic leakage. Postoperative anastomotic leakage of rectal cancer is a life-threatening complication with an incidence of 2.4% to 15.9% and a mortality rate of about 16%. The main risk factors include smoking, alcohol consumption, obesity, diabetes and malnutrition. Anastomotic leakage not only affects the prognosis of patients, but also brings great psychological burden to patients. Therefore, to explore the risk factors of anastomotic leakage after rectal cancer surgery and to prevent the occurrence of anastomotic leakage has become the focus of clinicians. This article reviews the Influencing factors and predictive biomarkers of postoperative anastomotic leakage in rectal cancer, in order to provide help for clinicians.