To analyze the effects of neoadjuvant chemoradiotherapy and intestinal wall edema on anastomotic leakage after total mesorectal resection（TME）.

Clinical data of 96 patients with medium-low rectal cancer who received neoadjuvant chemoradiotherapy + laparoscopic TME from January 2019 to December 2021 were retrospectively analyzed. By rating intestinal wall edema and tumor lesion fibrosis，surgery-related indexes and postoperative complications of patients with different grades were observed. The effects of intestinal wall edema and tumor fibrosis on the occurrence of anastomotic leakage were analyzed. SPSS 26.0 was used to analyze the data，and the measurement data were represented by（

In 96 patients with rectal cancer，there were 0 cases of grade 0，46 cases of grade Ⅰ，35 cases of grade Ⅱ，and 15 cases of grade Ⅲ intestinal wall edema. There were 0 cases of tumor fibrosis grade 0，37 cases of grade Ⅰ，41 cases of grade Ⅱ，and 18 cases of grade Ⅲ. The operation time of grade Ⅲ intestinal wall edema and tumor fibrosis was shorter than that of grade Ⅰ and grade Ⅱ，and the incidence of anastomotic leakage was lower than that of grade Ⅰ and grade Ⅱ（P<0.05）. Gender，BMI，tumor diameter，anastomotic distance from anal margin，preventive ostomy，intestinal wall edema，tumor fibrosis and preoperative hemoglobin and albumin levels were the factors affecting the occurrence of anastomotic leakage（P<0.05）. Logistic regression analysis showed that male，anastomotic distance from anal margin <5 cm，no preventive ostomy，intestinal wall edema grade Ⅲ，tumor fibrosis grade Ⅲ and preoperative albumin <35 g/L were independent risk factors for anastomotic leakage（P<0.05）.

Patients with higher grades of intestinal wall edema and tumor lesion fibrosis after neoadjuvant chemoradiotherapy had longer operation time and higher incidence of anastomotic leakage，which was an independent risk factor affecting the occurrence of anastomotic leakage.