Abstract: Objective: To investigate the cause and the prevention of anastomotic stoma fistula after total mesorectal excision for low rectal cancer.Methods: The results of surgery for distal rectal cancer with total mesorectal excision(TME) were reviewed.Results: Totally 315 patients underwent low anterior resection with TME in our hospital from 2002 to 2006.Seventeen of 315 patients treated by resection and anastomosis developed a clinically significant anastomotic leakage.The fistula healing time was(24.2±11.3) days.Two patients who were managed operatively were cured.Fifteen patients were managed conservatively.Thirteen of 15 were cured while the other both died.Conclusions: The incidence of anastomotic leakage is relatively low.There are many causes leading to the anastomotic fistulas which include operative capacity,preoperative preparation and total immunutrion and drainage.