Abstract:   Objective  To investigate the effect of restrictive transfusion practice on anastomotic leakage and infectious complications after surgery of rectal cancer.  Methods  Patients with rectal cancer receiving restorative proctectomy were divided into four groups based on the perioperative lowest haemoglobin（Hgb）level and transfusion status：Group 1 with Hgb level ≥100g/L and Group 2 with Hgb level ≥70g/L and <100g/L，neither group receiving a blood transfusion;Group 3 with Hgb level ≥70g/L and <100g/L and Group 4 with Hgb level <70g/L，both of whom received transfusion.Clinical characteristics，anastomotic leakage and infectious complications within 30 days of surgery were compared.Results  A total of 289 patients with a mean age of(58.2±10.8)years.There were 121（41.9%），115（39.8%），32（11.1%）and 21（7.3%）patients in Group 1，2，3，and 4，respectively.There were statistically significant differences among the groups in the rates of chemotherapy use，periperative Hgb，preoperative albumin level，intraoperative blood loss，tumour size and tumor stage.The unadjusted rates of overall infectious complications were 16.5%，28.7%，40.6% and 52.4% in the Group 1，2，3 and 4，respectively.Conclusion  Blood transfusion for perioperative Hgb level ≥70g/L is associated with higher postoperative surgical site infection，overall infectious complications and postoperative anastomotic fistula in rectal cancer patients.
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