To compare the surgical efficacy and short-term postoperative complications of anastomotic reinforcement (AR) and anastomotic unreinforcement (AU) in radical resection of middle and low rectal cancer.

The propensity score matching method was used to match AR and AU in 498 patients with mid-low rectal cancer who underwent radical resection for rectal cancer from January 2019 to December 2021. The surgical effects and short-term postoperative complications were compared between the two groups.

A total of 238 patients were paired (119 patients in each group). The clinical characteristics of the two groups were similar. Compared with AU Group, AR group had longer operation time (95.6±13.5 min vs. 84.3±15.2 min, t=6.07, P＜0.001), lower proportion of stoma and intraoperative preventive stoma (5.88% vs. 22.69%, χ²=13.73, P＜0.001; 5.04% vs. 16.81%, χ²=8.46, P=0.004), lower incidence of symptomatic anastomotic leakage (Grade B/C) and anastomotic bleeding (3.36% vs. 11.76%, χ²=13.73, P=0.014; 3.36% vs. 17.65%, χ²=12.92, P＜0.001). There was no difference in intraoperative blood loss, intestinal function recovery and postoperative hospital stay between the two groups. In addition, male, BMI≥24 kg/m², diabetes, neoadjuvant chemotherapy, distance＜5 cm from the anal verge were independent risk factors for anastomotic leakage. AR significantly reduced the incidence of anastomotic leakage in high-risk patients (risk factors ≥2) (χ²=5.10, P=0.024), while there was no difference in low-risk patients (risk factors <2).

Intraoperative anastomotic reinforcement for middle and low rectal cancer has significant advantages in reducing stoma rate, anastomotic leakage and anastomotic bleeding, especially in high-risk patients.