ObjectiveTo investigate the association between the preoperative nutritional risk and anastomotic leakage following anterior resection for the rectal cancer. MethodsA total of 321 patients with rectal cancer underwent anterior resection in our hospital between January 2008 and December 2013 were retrospectively analyzed. Preoperative nutritional status was evaluated using NRS 2002. Correlation of clinicopathologic characteristics with postoperative anastomotic leakage was evaluated using single factor analysis and Logistic regression model. ResultsAmong the 321 patients, the incidence of postoperative anastomotic leakage was 5.6% (18/321). Single factor analysis showed that the NRS2002 score≥3, clinicalpathologic stage (Ⅲ-Ⅳstage) and distance of tumor from the anal verge were the risk factors of anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Logistic regression analysis revealed that the NRS2002 score (OR=4.125, 95% CI=2.062-7.004), clinicalpathologic stage (OR=3.334, 95% CI=2.062-7.004) and the distance of tumor from the anal verge (OR=2.341, 95% CI=2.559-15.838) were the independent risk factors for anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Conciusions Preoperative NRS2002 score is helpful to predict the risk of anastomotic leakage after anterior resection of rectal cancer. Nutrition education should be strengthened to decrease the morbidity of the anastomotic leakage following anterior resection for the patients who's NRS2002 score≥3.