Purpose: to increase the effectiveness of treatment of patients with distal rectal cancer by improving the technique of pelvic reservoir formation to minimize the manifestations of low anterior resection syndrome. Object and methods of the study. The functional results of a prospective controlled study were analyzed, which included 80 patients who underwent total mesorectumectomy for distal rectal cancer. Results. A comparative analysis was conducted of the main group (n=40) with pelvic reservoir formation according to the clinic’s method and the comparison group (n=40) with standard end-to-end anastomosis. When studying the reservoir function of the rectum, the volume of the rectum in the main group was statistically higher than in the comparison group (p<0.001). The Wexner incontinence score was 6.2 and 7.3 at 12 months (p=0.001). The function of the internal rectal sphincter was less impaired in the main group (p=0.001). Conclusion. Based on the data obtained, the advantage of pelvic reservoir formation after total mesorectumectomy in patients with distal rectal cancer is justified.