Is Transanal total mesorectal excision (TME) as safe and effective as laparoscopic TME for low rectal cancer? A propensity score-matched analysis.

PURPOSE: Minimally invasive surgery for low rectal cancer is technically demanding because of the restricted pelvic access and visualization. Transanal total mesorectal excision (TaTME) was developed to address these challenges, but concerns remain regarding its safety and oncological validity. We conducted this study to compare the short-term surgical outcomes and long-term oncological results of TaTME with those of conventional laparoscopic TME (LapTME).

METHODS: The subjects of this retrospective review were 154 patients who underwent radical resection for low rectal cancer between 2009 and 2023. Patients were categorized into a TaTME group (n = 95) and a LapTME group (n = 59). Propensity score matching (PSM) was performed to minimize selection bias, yielding 44 matched pairs. We then compared the surgical and oncological outcomes of the two groups.

RESULTS: TaTME was associated with significantly shorter operative times (330 vs. 394 min; P = 0.020), less blood loss (0 g vs. 68 g; P < 0.001), and fewer postoperative complications (Clavien-Dindo ≥ II: 25.0% vs. 54.8%; P < 0.001), but a higher rate of diverting ileostomy (65.9% vs. 38.6%; P = 0.018). Long-term oncological outcomes, including survival and local recurrence, were comparable.

CONCLUSION: TaTME improves perioperative outcomes without compromising oncological safety. With proper training and technique, TaTME is a safe and effective option for low rectal cancer surgery.