Coloanal anastomosis offers an impressive 5-year stoma-free survival rate for patients with locally advanced rectal cancer.

• 5-year stoma-free survival rate is 88.9% at a median follow-up of 53 months.
• Factors that worsen survival: BMI ≥ 35 kg/m² (hazard ratio 3.80), handsewn anastomosis with mucosectomy (hazard ratio 5.58), and local recurrence (hazard ratio 6.51).
• Major postoperative morbidity rate stands at 7.9%.

Surgeons should consider these factors during patient selection and surgical planning to optimize outcomes.