Transanal total mesorectal excision achieves equivalent oncologic resection compared to laparoscopic approach, but with functional consequences

This study compared transanal total mesorectal excision (taTME) to laparoscopic total mesorectal excision (laTME) for the treatment of low rectal cancer. Adequacy of oncologic resection as well as postoperative outcomes were analyzed. We retrospectively reviewed all proctectomy for low rectal cancer by a single surgeon at our institution from January 2014 to September 2019. There were 20 taTME and 30 laTME patients. TaTME patients had more distal tumors with no difference in pathologic resection margins or frequency of positive distal margin. Operative times were longer for taTME, but there were no differences in short-term outcomes or complications. TaTME patients had a higher rate of postoperative fecal incontinence. TaTME may be a good option for the most distal tumors, when distal margins may be compromised. TaTME provides equivalent oncologic resection, but there is a higher incidence of postoperative fecal incontinence. •Comparison of transanal total mesorectal excision to laparoscopic total mesorectal excision for the treatment of low rectal cancer.•Transanal total mesorectal excision in rectal cancer achieves equivalent oncologic resection quality compared to laparoscopic total mesorectal excision.•Transanal total mesorectal excision in distal rectal cancer is associated with higher incidence of postoperative fecal incontinence.