Abstract Aim Extraperitoneal rectal resection combined with complete peritonectomy of the pelvis in patients with peritoneal metastases is associated with a high rate of morbidity and mortality due to anastomotic leakage (AL). Therefore, many centres tend to perform loop ileostomy to reduce the clinical impact of AL. The aim of this study was to analyse the need for protective stoma creation in this patient group to avoid major complications and mortality in the case of AL. Method We analysed 53 patients who underwent extraperitoneal rectal resection from 409 consecutive patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) at our department between January 1997 and December 2016. Results The mean age of the patients was 56.7 (SD 12.2) years and the mean Peritoneal Cancer Index was 24.6 (SD 12.0). Complete cytoreduction was achieved in 33 patients (62.3%). Six patients received an ileostomy or a colostomy, five of six with permanent intention. One patient (2.1%) developed AL postoperatively. Overall, 21 patients (39.6%) developed surgical complications, while 41 (77.3%) developed medical complications. The mortality rate was 7.5% ( n = 4). In total, 26 patients (49.1%) developed Clavien–Dindo Grade III/IV complications. Conclusions These results demonstrate the safety of colorectal anastomosis in combination with HIPEC in the absence of loop ileostomy. Loop ileostomy may be omitted for patients with low risk for AL in experienced centres with adequate postoperative care, possibilities for postoperative assessment and radiological intervention to avoid stoma‐related complications and increase the quality of life of patients with peritoneal metastases.