Transanal total mesorectal excision: Current status, clinical outcomes and future perspectives

Colorectal cancer (CRC) remains the third most common malignancy worldwide, posing a severe threat to global public health. Total mesorectal excision (TME) is the gold standard for curative resection of rectal cancer, yet conventional laparoscopic TME (laTME) faces substantial technical challenges in complex anatomical settings such as a narrow male pelvis or obesity, which may compromise surgical quality and oncological outcomes. Transanal total mesorectal excision (taTME), a novel minimally invasive surgical technique derived from natural orifice transluminal endoscopic surgery (NOTES), reverses the traditional top-down pelvic dissection approach to a bottom-up one, providing superior visualization and precision in the distal pelvic dissection. Since its first clinical application, taTME has rapidly evolved into a viable surgical platform for mid-low rectal cancer, and accumulating evidence has confirmed its feasibility, safety, and oncological efficacy. This review comprehensively elaborates on the developmental trajectory, optimal patient selection criteria, surgical fundamentals, and the learning curve of taTME, while evaluating its pathological, long-term oncological, and functional outcomes. Furthermore, we discuss the emerging research directions, including robotic-assisted taTME (R-taTME) and the clinical extension of taTME to non-oncological anorectal disorders. Finally, we prospect the future development of taTME, aiming to provide a comprehensive reference for its standardized clinical application and further research.