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Colorectal cancer is the second and third most prevalent gastrointestinal tract malignancy among women and men. Over the past few decades, the incidence and mortality of colorectal cancer has gradually increased in China. Many studies have indicated that the robotic surgery system addresses several limitations of laparoscopic surgery and is a safe and feasible surgical approach. However, preservation of the left colic artery (LCA) during robotic total mesorectal excision (R-TME), along with short-term surgical outcomes and complications, has always been the focus of surgeons. Therefore, the present study aimed to analyze the short-term surgical effects of LCA preservation and postoperative complications within 30 days in patients with and without LCA preservation during R-TME. In this retrospective cohort study, we collected and analyzed the clinical data of R-TME performed at the anorectal Department of Gansu Provincial Hospital between January 2018 and January 2023. (In our center, the robotic Da Vinci Xi surgical system is utilized for surgical procedures.) The patients were divided into 2 groups according to whether the LCA was preserved during total mesorectal excision. A total of 150 patients were included in this study; 69 patients underwent LCA preservation, and 81 underwent LCA non-preservation surgeries. In the LCA preservation group, the first postoperative ventilation time (3.2 ± 1.3 days vs 4.2 ± 1.8 days, P = .000) and the time of the first postoperative fluid diet (4.9 ± 1.1 days vs 5.1 ± 1.6 days, P = .001) were significantly improved, and the incidence of protective ileostomy (4.3% vs 14.8%, P = .033) was significantly reduced compared with that in the LCA non-preservation group (P < .05). The overall complication rates within 30 days in the 2 groups were not significantly different. However, the incidence of anastomotic leakage in the LCA preservation group was significantly lower than that in the LCA non-preservation group (0.0% vs 7.4%, P = .021). R-TME is safe and feasible for the preservation of the LCA, and LCA preservation can promote gastrointestinal function recovery. In addition, LCA preservation ensures the extent of No. 253 lymph node dissection, significantly reduces the incidence of anastomotic leakage and ileal protective fistula and improves the patients' quality of life.