An analysis of operative mortality for carcinoma of the rectum in the German Study Group Colo-Rectal Carcinoma (SGCRC) comprising 1115 operated patients, found a total operative mortality rate of 4.3% and a 30-day-mortality rate of 2.8%. Advanced age, severe concurrent disease, anastomotic leakage in anterior resections and institution were found to be factors with independent significant influence. In anterior resections, especially low anterior resections, with protective enterostomy, the lower rates of anastomotic leakage and mortality emphasize the advantages of protective enterostomy.