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There is evidence that elective colonic surgery without mechanical bowelpreparation (MBP) is safe. Few data are available for rectal surgery. This randomized trial aimed to compare the outcome of patients having rectal resection for cancer with or without MBP.Patients scheduled for rectal cancer sphincter saving resection were randomized to receive MBP or not. Theprimary end point was the 30-day morbidity rate. Secondary end points included mortality, anastomotic leakage, major morbidity (Dindo III or more) and hospital stay.Between 2007 and 2009, 178 (103 males) patients were included with 89 in each group. The overall and infection morbidity rates were significantly higher in the no MBP versus the MBP group (44% vs 27% (P = 0.018) and 34% vs 16% [P = 0.005]). There was no significant difference in anastomotic leakage and major morbidity between the no MBP and the MBP groups [19% vs 10% (NS) and 18% vs 11% (NS)]. Mortality (1.1% vs 3.4%) and hospital stay (12 vs 11 days) were similar.This is the first randomized trial comparing MBP without MBP. It demonstrated that rectal cancer surgery without MBP was associated with a higher risk of morbidity including infecgtion. It supports to the continued use of MBP in rectal cancer surgery.