Participants in this arm do not undergo the intervention of a protective ileostomy. The management for this group involves. The outcomes for this arm will be assessed in comparison to the group that receives the protective ileostomy. This arm serves as the control/comparative group to evaluate the impact of the intervention on the specified outcomes.

Ileostomy Arm Description: Participants in this arm undergo the intervention of a protective ileostomy. The surgical procedure involves. This arm serves as the experimental group to evaluate the impact of the protective ileostomy on specified outcomes. The outcomes for this arm will be compared to those in the non-interventional (comparative) arm to assess the effectiveness and potential benefits of the ileostomy intervention.

Preparation of the bowel was performed before surgery with the administration of intravenous perioperative antibiotic prophylaxis. The surgical procedure was performed by laparotomy, with resection of the rectum and mesorectum (TME) up to the level of the pelvic diaphragm, sparing the autonomic nerves. End-to-end anastomosis was performed either with a stapler or by hand-sewn.

Anastomosis leakage is defined as the unintended escape of gastrointestinal contents from the site of surgical anastomosis, typically occurring after a low anterior rectal (LAR) resection. It is a critical postoperative complication that can lead to various adverse effects, including peritonitis, abscess formation, and increased morbidity. The evaluation of anastomosis leakage involves careful monitoring for clinical signs, diagnostic imaging, and, if necessary, interventions such as reoperation or drainage procedures. The occurrence and management of anastomosis leakage serve as a key primary outcome measure in this study, contributing valuable insights into the efficacy and safety of the protective ileostomy intervention

Surgical Site Infection is a postoperative complication characterized by the invasion of microorganisms into the surgical incision or the deeper tissues surrounding the operative site. In the context of this study, the evaluation of SSI involves monitoring for clinical signs of infection, such as redness, swelling, warmth, or discharge, and may require additional diagnostic assessments. The occurrence of Surgical Site Infection is a critical parameter, impacting patient recovery, healthcare costs, and overall postoperative morbidity. As a primary outcome measure, the study aims to comprehensively assess the incidence and characteristics of SSI, providing crucial insights into the effectiveness of the protective ileostomy intervention.

The Duration of Surgery is a critical parameter measured from the initiation of the surgical incision to the closure of the incision. This outcome is pivotal in understanding the efficiency and complexity of the surgical procedure. It encompasses the time required for key stages, such as tumor resection, anastomosis, and closure. A shorter duration may indicate a more streamlined and less invasive procedure, potentially contributing to reduced patient morbidity and improved postoperative outcomes. Monitoring the Duration of Surgery as a primary outcome provides valuable insights into the procedural intricacies and overall efficiency of the interventions, aiding in the evaluation of the protective ileostomy's impact on surgical timelines.