Short- and Long-Term Outcomes of Transanal Total Mesorectal Excision for Rectal Cancer: A Single-Center Retrospective Study of 100 Patients.

PURPOSE: Transanal total mesorectal excision (TaTME) has been introduced to facilitate distal rectal dissection; however, concerns regarding its oncological safety persist. This study evaluated the outcomes of TaTME in a real-world setting. METHODS: Between 2019 and 2025, 123 patients underwent TaTME at our institution. After excluding patients with pathologically confirmed Stage IV disease, combined resection of adjacent organs, and local recurrence, 100 patients were retrospectively analyzed. RESULTS: Median age was 67 years, and 64% were male. Median tumor distance from the anal verge was 6 cm. Procedures included low or ultra-low anterior resection (n = 67), intersphincteric resection (n = 21), abdominoperineal resection (n = 11), and Hartmann's procedure (n = 1). A simultaneous two-team approach, consisting of a surgeon and a camera assistant for each phase, was used in 98 patients. The median operative time and blood loss were 211.5 min and 5 mL, respectively. Median postoperative hospital stay was 15 days. Clavien-Dindo grade≥IIIa complications occurred in 12 patients, and no 90-day mortality was observed. A positive circumferential resection margin was observed in one patient (1%). Median follow-up was 1126 days. Recurrence occurred in 17 patients (17%), including pelvic local recurrence in four patients (4%). The estimated 3-year overall survival (OS) rates for pathological Stages 0, I, II, and III were 100%, 100%, 90.0%, and 92.6%, respectively. The estimated 3-year recurrence-free survival (RFS) rates were 100%, 91.6%, 77.4%, and 66.6%, respectively. CONCLUSION: TaTME was associated with acceptable perioperative and oncological outcomes in a community hospital setting.