<p>Leriche syndrome patients exhibit chronic arterial occlusion from the lower abdominal aorta to the iliac arteries, but pelvic and lower extremity perfusion is maintained through collateral circulation. Surgical treatment for rectal cancer in Leriche syndrome patients requires careful evaluation in order to maintain adequate blood flow. We herein report a case of robot-assisted rectal cancer resection with anastomosis in a patient with Leriche syndrome. A 64-year-old man with a 7-year history of Leriche syndrome under pharmacological management had a positive fecal occult blood test at another hospital. A colonoscopy revealed rectal cancer, and the patient was referred to our institution for further evaluation and treatment. Preoperative contrast-enhanced computed tomography revealed collateral blood flow from the right internal iliac artery to the rectum. A robot-assisted anterior resection with anastomosis was planned. Intraoperative assessment of blood flow was performed using indocyanine green fluorescence imaging. The patient was discharged on postoperative day 11 without significant complications. This case suggests that robot-assisted rectal cancer surgery can be safely performed in patients with Leriche syndrome, provided that careful preoperative and intraoperative assessment of blood flow is conducted.</p>