Objective: To assess the effectiveness of three tubes for lavage, drainage and decompression on prevention of anastomotic leakage after total mesorectal excision (TME) for rectal cancer. Methods: Three hundred and thirty-two consecutive patients, who underwent TME for rectal cancer in the research institute of general surgery of Fuzhou general hospital of Nanjing military command, were randomly assigned into group A and B with 166 cases each. Patients of group A received the self-designed three tubes for lavage and drainage, while those of group B received the conventional drainage, and the drainage tubes were placed 5-cm above the rectal anastomotic stoma in all patients. The alterations in anorectal pressure and the incidence of anastomotic leakage of the two groups were observed. Results: The anorectal pressure reached the maximum level at the fourth postoperative day. No anastomotic leakage occurred in group A, while 11 cases in group B (6.62%, 11/166) developed anastomotic leakages that mostly occurred at the fourth postoperative day, and this showed a significant difference between the two groups (χ2=11.389，P=0.001). In group B, 9 cases of anastomotic leakage were cured by nonsurgical treatment and the other 2 cases resolved by proximal bypass enterostomy. No perioperative death occurred in the two groups. Conclusions: The three tubes for lavage, drainage and decompression are effective in prevention of anastomotic leakage after TME for rectal cancer.