Multiple linear stapler firings during double stapling technique (DST) is associated with anastomotic leakage (AL) after laparoscopic low anterior resection (LAR). We aim to investigate the risk factors and then to develop a deep learning model to predict the usage of ≥3 linear stapler cartridges during DST anastomosis.

Inclusion Criteria:

• 1) carcinoma of rectum confirmed by histopathological evaluation;
• 2) tumor located in the mid-low rectum (less than 10cm from the anal verge);
• 3) performance of DST anastomosis;
• 4) pelvic MRI obtained within 14 days before surgery.

Exclusion Criteria:

• 1) other anastomotic techniques (e.g., trans-anal rectal excision);
• 2) Hartmann's operation or other procedures without anastomosis;
• 3) the number of linear stapler cartridges was not traceable in the operative report.

patients who underwent Laparoscopic anterior resection for mid-low rectal cancer at Ruijin Hospital, Shanghai, People's Republic of China, between 2016 and 2021.