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Adenocarcinoma of the rectum exfoliates viable cells, which have the ability to implant. These are decreased by intraoperative rectal washout. There is no conclusive evidence of the effect of rectal washout on local recurrence after rectal cancer surgery.Data from the Swedish Rectal Cancer Registry were analysed. This covers 97% of rectal cancer patients diagnosed in the country with 2% lost to follow up. Included were patients without distant metastases operated by anterior resection during 8 years (1995-2002) and followed for 5 years. Rectal washout was performed at the discretion of the surgeon.Four thousand six hundred and seventy-seven patients (3749 washout, 851 no washout, 77 information missing) were analysed. The local recurrence rate was 10.2% in patients without and 6.0% in patients with rectal washout (P < 0.001). Univariate analysis with logistic regression favoured washout with an odds-ratio of 0.56 (95% CI 0.43-0.72, P < 0.001). Multivariate analysis favoured washout with an odds-ratio of 0.61 (95% CI 0.46-0.80, P < 0.001). Multivariate analysis restricted to patients operated for cure was consistent with these findings, odds-ratio 0.59 (95% CI 0.44-0.78, P < 0.001).Rectal washout should be performed in anterior resection for rectal cancer to reduce the risk of local recurrence.