Anastomotic leakage (AL) after anterior resection for rectal cancer (ARRC) is associated with an increased risk for a prolonged hospital stay, reoperation, local recurrence, and 30-day postoperative mortality.Reported rates of AL ranged from 4% to 26%.The aims of this study were to describe our techniques in the prevention of AL after ARRC and to assess the outcomes.Ahistorical cohort of 659 consecutive patients with ARRC a tour institution from January 1, 2006 to June 30, 2011 was evaluated.The association between surgical techniques and the risk for AL was analyzed.Of the 659 patients, 539 (81.8%) patients had lower or mid rectal cancer and 120 (18.2%) had upper rectal cancer.We established standard protocols for total mesentery excision and wide mesentery excision.Following techniques were developed and used: 1) perineal boost;2) vaginal boost;3) catheter rotating traction;4) measuring technique of diameter of rectum to be dissected;5) testing of closed distal rectal end with a closed-system;6) distal rectal closed-side comer transfixion and traction;7) purse string of proximal colon and the fastening of nail retainer;8) trimming of nail retainer colon wall epiploicae appendices;9)selection of puncture point and puncture technique;10) examination of the anastomosis with a "filling tire" test;11) rectal decompression drainage and irrigation;12) pre sacral placement of trans abdomen, negative-pressure drainage tube.Using the above techniques, the overall AL rate in our cohort was 1.21%, which was lower than that reported in the literature.The rate of AL in our cohort was consistently low, being 4.1%, 1.9%, 0.8%, 0%, 0%, and 1.78%, 2006 to 2011, respectively.The described techniques appeared to be effective in reducing AL after ARRC, and clinically applicable.