Purpose This study compares the morbidity between patients with locally advanced rectal cancer who have had a pathological complete response (pCR) or not after neoadjuvant chemoradiotherapy and Total Mesorectal Excision (TME). Methods A retrospective cohort study was conducted from the Binational Colorectal Cancer Audit (BCCA), that identified patients with locally advanced rectal cancer (<15cm from anal verge) from 1st of January 2007 to 31st December 2019. Patients were included if they had locally advanced rectal cancer and had undergone neoadjuvant chemoradiotherapy and proceeded to surgical resection. Results There were 4584 patients that satisfied the inclusion criteria, 65% being male, with a mean age of 63 years, and 11% having pCR (ypT0N0). Both major and minor complications were higher in the TME without anastomosis group (17.3% vs 14.7%, and 30.6% vs. 20.8% respectively), and the 30-day mortality was 1.31%. In the TME with anastomosis group, pCR did not contribute to higher rates of surgical complications, but male gender (p<0.0012), Age (p<0.0001), pre-op N stage (p=0.0092) and ASA ≥ 3 (p<0.0002) did. PCR had no significant effect (p=0.44) but male gender (p=0.0047) and interval to surgery (p=0.015) contributed to higher rates of anastomotic leak. In the TME without anastomosis cohort, the only variable that contributed to higher rates of complications was ASA ≥ 3 (p=0.033). Conclusion Patients undergoing TME dissection for rectal cancer following NCRT showed no difference in complications whether they had achieved pCR or not.