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Neo-adjuvant chemo-radiotherapy followed by resection with total meso-rectal excision (TME) is thepreferred treatment for locally advanced rectal carcinoma. Anastomotic complications remain a significant source of morbidity. Previous studies have suggested that a good response to combined modality therapy may increase risk of anastomotic complications.Nine years data were collated on 143 patients at a single centre to establish the incidence of anastomotic complications, association with response to neo-adjuvant therapy and other clinicopathological factors. One hundred and thirty-five (94%) patients underwent resection with 101 (75%) anterior resections (64 males), 57 (56%) were classified as low and 76 (75%) had defunctioning ileostomy. Thirteen patients (9.6%) had abdomino-perineal excision of the rectum.Anastomotic complications included clinical leaks occurred in 13/101 (13%) patients and 3 (2.9%) developed colovesical fistulae. Five patients (4.9%) had subclinical leaks detected radiologically. The anastomosis waspreserved in 17 (85%). A good pathological response to neoadjuvant therapy was strongly associated with anastomotic complications (P = 0.011). A perioperative cardiac event was the only other clinical factor associated with anastomotic complications (P < 0.01).A greater risk of anastomotic complications in rectal carcinoma treated with neoadjuvant therapy followed by radical resection may bepresent if a good pathological response to therapy is observed.