To compare the effect of two prophylactic ileostomy methods in laparoscopic ISR for ultra-low rectal cancer.

The clinical data of 52 patients with LARC from June 2019 to June 2022 were retrospectively analyzed. All patients received neoadjuvant radiochemotherapy（nCRT）before receiving ISR and were divided into group A（distal margin distance <1 cm，n=24）and group B（distal margin distance ≥1 cm，n=28）according to the distance of distal margin. All data were processed by SPSS 22.0 software. Perioperative indicators and other measurement data were expressed by（

There were no significant differences in operation time，intraoperative blood loss，number of lymph node dissection，postoperative exhaust time and postoperative hospital stay between the two groups（P>0.05）. There were no significant differences in incision infection，anastomotic leakage，anastomotic hemorrhage，pelvic infection，intestinal obstruction and total complications between the two groups（P>0.05）. The median follow-up time was 30 months（11~47 months）. Kaplan-Meier analysis showed that cumulative overall survival（70.8%vs.78.6%）and disease-free survival（62.5%vs.75.0%）were not significantly different between the two groups（Log-Rank χ²=0.256，1.360，P=0.613，0.244）.

Patients with LARC with a distance of ≥1 cm and a distance of <1 cm at the distal incisional margin during ISR can achieve the same efficacy after nCRT，and the overall survival and disease-free survival of patients are not significantly affected.