A systematic review and meta-analysis of perioperative and oncological outcomes of transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer

Purpose To compare the perioperative and oncological outcomes between transanal (Ta) versus laparoscopic (La) total mesorectal excision (TME) for mid and low rectal cancer using available clinical studies formulated in a systematic review and meta-. analysis. Methods The preferred reporting items for systematic reviews and meta-analyses 2020 guidelines were followed. We systematically searched for literature published in the Embase, PubMed, Cochrane Library, Medline, and Web of Science up to 30/06/2025. Results This systematic review and meta-analysis reported results from all the available comparative studies between TaTME and LaTME. TaTME was significantly associated with a shorter length of postoperative hospital stay (mean difference -1.65, 95% CI, -2.93 to – 0.36, p = 0.01), lower postoperative complication (RR = 0.79,95% CI 0.63 to 0.98, P = 0.03) and lower local recurrence rate (mean difference -22.78, 95% CI -37.7 to – 7.85, p 0.003). In contrast, operative time, estimated blood loss, anastomotic leakage rate, readmission rate, mortality rate, and distant metastasis rate showed similar observations between TaTME and LaTME. Conclusion These findings are promising and suggest that TaTME may be a viable alternative for LaTME for patients with mid and low rectal cancer.