Short‐Term and 3‐Year Oncological Outcomes in Laparoscopic‐Assisted Trans‐Anal Pelvic Exenteration With Preserving Anal Sphincter for Locally Advanced Rectal Cancer

Purpose Pelvic exenteration (PE) for rectal cancer is highly invasive. The trans‐anal approach (Ta‐PE) offers a minimally invasive alternative. This study evaluates the perioperative and long‐term outcomes of laparoscopic‐assisted Ta‐PE. Methods A retrospective analysis was conducted on 17 patients who underwent laparoscopic‐assisted Ta‐PE with preserving anal sphincter between April 2018 and September 2024. Perioperative and oncological outcomes, including operative time, complications, hospital stay, and survival rates, were assessed. Results The median age was 64 years (nine men, eight women). Total‐PE was performed in 11 patients (64.7%), and posterior‐PE in 6 (35.3%). Urinary diversion was required in 13 (76.5%). Mean operative time was 464 min, with no conversions. Clavien–Dindo Grade III–IV complications occurred in four cases (23.5%), including pelvic abscess ( n = 3) and postoperative bleeding ( n = 1). No reoperations or 90‐day mortality were observed. The median hospital stay was 21 days. Three‐year overall survival, disease‐free survival, and local control rates were 69.9%, 45.4%, and 93.8%, respectively. Conclusion Laparoscopic‐assisted Ta‐PE is a promising minimally invasive option for locally advanced rectal cancer, with favorable perioperative outcomes and effective local disease control. Larger studies are needed to confirm these findings and refine patient selection.