BACKGROUND Anastomotic leakage (AL) is an important cause of morbidity after surgery for rectal cancer. OBJECTIVE to analyze the risk factors associated with anastomotic leakage after anterior resection for rectal adenocarcinoma. METHODS We collected data from all the patients who had surgical resection with an anastomosis, for rectal adenocarcinoma at the Surgical Clinic C (Ibn Sina Hospital, Rabat, Morocco), between January 2001 and December 2010. The associations between variables and anastomotic leakage were studied using univariate and multivariate analysis. RESULTS Our study included 130 patients. Anastomotic leakage occurred in 28 patients (21.5%). Univariate and multivariate analysis showed that the rate of anastomotic leakage was significantly higher in patients who received preoperative radiotherapy (34.2% vs. 12 %, p = 0.002 - OR 3.8 - CI 95%: 1.5 - 9.4). There was no significant difference in the rate of AL between patients with or without a protective stoma. In the group of patients with AL, the rate of reoperation was significantly lower in patients with a stoma protection (31.8% vs. 83.3%, p = 0.04). CONCLUSIONS Radiotherapy is a risk factor for anastomotic leakage. The systematic design of a protective stoma in patients receiving neoadjuvant radiotherapy is advisable to reduce the rate of reoperations associated with AL.