〔Abstract〕 Objective To identify risk factors for anastomotic leakage and to create a nomogram for precise prediction of anastomotic leakage after anterior resection for rectal cancer. Methods A case-control study was conducted to retrospectively analyze the clinicopathological data of 326 consecutive patients who underwent sphincter-preserving surgery for rectal cancer. Univariate and multivariable logistic regression analysis were used to determine independent risk factors associated with postoperative anastomotic leakage. A nomogram was constructed based on the selected independent risk factors to predict anastomotic leakage. The accuracy and predictability of the model were evaluated by using a bootstrapped-concordance index and calibration plots. Results Univariate and multivariate analysis identified the following variables as independent risk factors for anastomotic leakage: gender(male)(OR=2.847,95%CI:1.197～6.771), BMI(≥24 kg/m2)(OR=3.790,95%CI:1.812～7.927), M stage(M1)(OR=3.176,95%CI:1.122～8.989) and distance of tumor to anal verge(≤7 cm)(OR=2.992,95%CI:1.407～6.362). We created a nomogram with high discriminative ability(concordance index, 0.755) validate by the Bootstrap internal verification method. The area under the curve value, which evaluated the predictive performance of external validation, was 0.773(95%CI:0.712～0.844). The validation of the model showed that the predicted values and the observed values were basically consistent, indicating that the nomogram prediction model had a good predictive ability. Conclution Male, BMI≥24 kg/m2,M1 stage and distance from anal verge to tumor≤7 cm were independently associated with anastomotic leakage formation. The nomogram prediction model is helpful to predict the probability of AL after sphincter-preserving surgery.