Abstract

Background: Total mesorectal excision (TME) remains the cornerstone of curative surgery for mid-low rectal cancer. While laparoscopic TME (LapTME) is a well-established minimally invasive technique, transanal TME (TaTME) has emerged to overcome technical challenges in a narrow pelvis. However, robust long-term oncological safety data, particularly 3-year local recurrence (LR) and survival rates, are crucial for evaluating its clinical value.
Methods: This systematic review synthesizes evidence from 35 high-quality studies, including randomized controlled trials, retrospective cohort studies, meta-analyses, and propensity score-matched analyses, to compare TaTME and LapTME for mid-low rectal cancer (≤12cm from the anal verge).
Results: Current evidence suggests no statistically significant difference in 3-year LR rates between TaTME and LapTME in large, well-conducted trials (e.g., TaTME vs. LapTME: 5.1% vs. 4.8%, P>0.05). Similarly, 3-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) rates are largely comparable between the two techniques. TaTME demonstrates advantages in specific scenarios, such as improved circumferential resection margin (CRM) positivity rates in low-lying tumours and reduced conversion rates. However, concerns regarding unique recurrence patterns and a significant learning curve effect associated with TaTME warrant careful consideration.
Conclusion: For mid-low rectal cancer, TaTME and LapTME offer equivalent 3-year local control and survival outcomes when performed by experienced surgeons. TaTME provides a valuable alternative, particularly in anatomically challenging cases, but its application should be mindful of the learning curve and patient selection. The paramount goal remains achieving a high-quality TME specimen, regardless of the surgical approach.

Keywords:Rectal cancer; Total mesorectal excision; TaTME; LapTME; Local recurrence; Survival outcomes; Minimally invasive surgery