Selective Defunctioning Stoma in Low Anterior Resection for Rectal Cancer

Inclusion Criteria: * Adult patients with rectal cancer planned for a low anterior resection with anastomosis by TME with any surgical approach Additional inclusion criteria for randomised part of the study: * Patients aged less than 80 years * Patients with American Society of Anesthetists' (ASA) fitness grade I or II as determined by the anaesthesiologist or the surgeon * Patients without clear radiological signs of distant disease before rectal cancer surgery (previous metastatic surgery is no exclusion criterion) * Anastomotic leak risk score of 0-1 * Willingness to be randomised Exclusion Criteria: * Insufficient command of Swedish, Norwegian, Danish or English to understand questionnaires or consent * Emergency rectal resection (tumour resection due to large bowel obstruction, perforation, etc) * Pregnancy or breastfeeding Additional exclusion criteria for randomised part of the study * Previous pelvic irradiation (due to e.g. gynaecological or urological cancer) * Preoperative tumour perforation or pelvic sepsis * Beyond TME surgery and/or concurrent resection of other organ * Concurrent corticosteroid treatment (prednisone-equivalent dosage ≥10 mg daily) * Planned postoperative chemotherapy * Smoking not completely ceased four weeks before surgery * Excessive alcohol consumption with social and medical consequences (as judged by the surgeon in charge) Intraoperative exclusion criteria for randomised part of the study -\>2 staple firings for rectal transection * Intraoperative blood loss ≥250 ml for minimally invasive surgery * Intraoperative blood loss ≥500 ml for open or converted surgery * More than one intraabdominal anastomosis performed * Incomplete doughnuts * Air-leak test positive * Any significant intraoperative adverse event at the discretion of the operating surgeon (e.g. ureterotomy, bowel or tumour perforation, major medical event - pulmonary embolism, cardiac arrhythmia) (Gawria, 2022) * TME with anastomosis ultimately not done