Background. Since Sylla and Lacy successfully reported the transanal total mesorectal excision in 2010, taTME was considered to have the potential to overcome some problematic laparoscopic cases in male, low advanced rectal cancer. However, the evidence is still lacking. This study compared the short and long outcomes of taTME with laTME in these “challenging” patients to explore the advantages of taTME among the patients. Method. After propensity score matching analysis, 106 patients were included in each group from 325 patients who met the including standard. Statistical analysis was used to compare the differences of perioperative outcomes, histopathological results, and survival results between taTME and laTME groups. Results. The mean time of pelvic operation in the taTME group was significantly shorter than in the laTME group ( 62.2 ± 14.2 mins vs 81.1 ± 18.9 mins, P = 0.003 ). The complication incidence rate and the rate of protective loop ileostomy in the taTME group were significantly lower than those in the laTME group (19.8% vs 38.7%, P = 0.003 and 70.8% vs 92.5%, P < 0.001 ). In long-term result, there was no significant difference between the two groups for 3-year OS (87.3% vs 85.4%, P = 0.86 ) or 3-year DFS (74.9% vs 70.1%, P = 0.92 ). The 2-year cumulative local recurrence rate was similar between the two groups (1.1% vs 5.8%, P = 0.22 ). Conclusion. This study demonstrated that taTME might reduce the incidence of postoperative complications, especially of anastomotic leakage in these “challenging” patients. taTME may be considered to have clear advantages for “challenging” patients.

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