Abstract: Objective To investigate the application of prophylactic ileostomy in treatment of elderly rectal cancer patients with fast track surgery. Methods From June 2018 to March 2019, 58 rectal cancer patients with low anterior resection in Dandong City Central Hospital of Liaoning Province were selected and divided into two groups according to the operation modes. Low anterior resection and prophylactic ileostomy were performed in the stoma group(n=21), while low anterior resection was only performed in the non-stoma group(n=37). The time of anal exhaust(the time of stoma exhaust in the stoma group), the time of tolerating semi-fluid food, postoperative hospitalization time and time of the first chemotherapy were compared between the two groups. The score of quality of life and score of anterior resection syndrome were compared between the two groups. Results In the stoma group, the distance between the anastomotic stoma and anus, the time of exhaust, the time of tolerating semi-fluid food, the hospitalization time and the time of the first chemotherapy were significantly shorter than those in the non-stoma group(P<0.05). The incidence of complications was 18.92%(7/37)in the non-stoma group and 19.05%(4/21)in the stoma group, and there was no significant difference in the incidence of complications between the two groups(P>0.05). The scores of quality of life, emotional - function, diarrhea and anterior resection syndrome at 6 months after operation in the stoma group were significantly better than those in the non-stoma group(P<0.05). Conclusion Prophylactic ileostomy can effectively improve the postoperative symptoms of anterior resection syndrome, shorten the length of hospital stay and improve the quality of life in patients with rectal cancer. Prophylactic ileostomy should be performed routinely for the elderly patients with lots of basic diseases or low anastomotic position.