The evolution of transanal approaches in rectal cancer surgery

Minimally invasive techniques are progressively transforming colorectal (CRC) surgery. Given the high mortality and morbidity rates associated with conventional surgical treatments for CRC, the development of less invasive alternatives is crucial. The long-established use of transanal platforms for local excision of early-stage rectal cancers paved the way for the development of a transanal approach to total mesorectal excision (TME). Transanal total mesorectal excision (taTME) has emerged as a novel technique for treating low CRC, offering superior and more accurate visualization of the presacral mesorectal plane compared to the abdominal approach, and providing particular advantages in the narrow male pelvis. The current data on oncological and functional outcomes are promising. The transanal transection and single-stapled anastomosis (TTSS) approach represents the latest advancement in transanal techniques for treating low CRC. Evolving from taTME, it provides a more controlled and potentially safer anastomotic technique. However, the data are still preliminary, and larger studies are needed to validate its effectiveness. This review explores the evolution of minimally invasive and transanal surgical techniques for low CRC treatment, comparing outcomes across various approaches with a focus on patient selection criteria and oncological results.