{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:05:49Z","timestamp":1791324349404,"version":"4.3.1"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Oncologic outcomes in mid and low rectal cancer depend critically on the quality and reproducibility of total mesorectal excision. Transanal total mesorectal excision (TaTME) has been introduced to address technical challenges in distal pelvic dissection and margin acquisition in selected patient populations. However, concerns regarding oncologic safety have been raised when TaTME is implemented outside controlled trial settings. Evidence from routine clinical practice is therefore needed to determine whether these outcomes are reproducible under real-world conditions. To compare 3-year (mid-term) oncologic outcomes between one-team TaTME and laparoscopic total mesorectal excision (LapTME) in patients with mid and low rectal cancer treated under routine clinical practice conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study was conducted at a tertiary academic hospital. From January 2018 to May 2022, 256 consecutive patients with mid and low rectal adenocarcinoma undergoing curative-intent total mesorectal excision were included. Patients were categorized according to surgical approach (TaTME,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009129; LapTME,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009127). Propensity score matching was adjusted for baseline differences, yielding a matched cohort of 170 patients (TaTME,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009108; LapTME,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200962). The median follow-up duration was 48\u00a0months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After matching, baseline characteristics were well balanced between groups. Median operative time was longer and protective stoma formation was more frequent in the TaTME group, whereas intraoperative blood loss and rates of major postoperative complications were similar between groups. All specimens had negative distal and circumferential resection margins. The distribution of distal resection margin lengths was more tightly clustered in the TaTME group, indicating greater consistency in distal margin acquisition. At 3\u00a0years, local recurrence occurred in 3. 7%of patients in the TaTME group and 4. 8%in the LapTME group, and distant metastasis occurred in 13. 0 and 14. 5%, respectively. Three-year disease-free survival was 83. 3%in the TaTME group and 82. 3%in the LapTME group, and 3- year overall survival was 88. 9and 90. 3%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this single-center study conducted under routine clinical practice conditions, one-team TaTME was associated with 3-year oncologic outcomes comparable to those of LapTME for patients with mid and low rectal cancer. These findings suggest that, when performed by experienced surgical teams, one-team TaTME does not appear to compromise oncologic outcomes and may be appropriately considered within contemporary rectal cancer surgery under routine clinical conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-13057-0","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:28:12Z","timestamp":1783524492000},"page":"7637-7649","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of transanal vs laparoscopic total mesorectal excision for mid and low rectal cancer under routine clinical practice conditions"],"prefix":"10.1007","volume":"40","author":[{"given":"Chen","family":"Su","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junfeng","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanxin","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinggang","family":"Ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5858-6788","authenticated-orcid":false,"given":"Hongyu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"issue":"4","key":"13057_CR1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000036859","volume":"103","author":"Z Yi Chi","year":"2024","unstructured":"Yi Chi Z, Gang O, Xiao Li F et al (2024) Laparoscopic total mesorectal excision versus transanal total mesorectal excision for mid and low rectal cancer: A systematic review and meta-analysis. Medicine (Baltimore) 103(4):e36859. https:\/\/doi.org\/10.1097\/MD.0000000000036859","journal-title":"Medicine (Baltimore)"},{"issue":"5","key":"13057_CR2","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1007\/s10151-022-02739-1","volume":"27","author":"W Seow","year":"2023","unstructured":"Seow W, Dudi-Venkata NN, Bedrikovetski S, Kroon HM, Sammour T (2023) Outcomes of open vs laparoscopic vs robotic vs transanal total mesorectal excision (TME) for rectal cancer: a network meta-analysis. Tech Coloproctol 27(5):345\u2013360. https:\/\/doi.org\/10.1007\/s10151-022-02739-1","journal-title":"Tech Coloproctol"},{"issue":"1","key":"13057_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/SLA.0000000000005523","volume":"277","author":"H Liu","year":"2023","unstructured":"Liu H, Zeng Z, Zhang H et al (2023) Morbidity, mortality, and pathologic outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer short-term outcomes from a multicenter randomized controlled trial. Ann Surg 277(1):1\u20136. https:\/\/doi.org\/10.1097\/SLA.0000000000005523","journal-title":"Ann Surg"},{"issue":"1","key":"13057_CR4","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1111\/codi.15927","volume":"24","author":"NAN Kumar","year":"2022","unstructured":"Kumar NAN, Usman N, Rajan K, Shetty PS, Crithic VHV, Rao VNV (2022) Laparoscopic total mesorectal excision for low rectal cancer - a step by step approach - a video vignette. Colorectal Dis 24(1):141. https:\/\/doi.org\/10.1111\/codi.15927","journal-title":"Colorectal Dis"},{"issue":"3","key":"13057_CR5","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/s1470-2045(13)70016-0","volume":"14","author":"MH van der Pas","year":"2013","unstructured":"van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): Short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210\u2013218. https:\/\/doi.org\/10.1016\/s1470-2045(13)70016-0","journal-title":"Lancet Oncol"},{"issue":"7","key":"13057_CR6","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1089\/lap.2019.0828","volume":"30","author":"M Zuhdy","year":"2020","unstructured":"Zuhdy M, Elmore U, Shams N et al (2020) Transanal versus laparoscopic total mesorectal excision: a comparative prospective clinical trial from two centers. J Laparoendosc Adv Surg Tech A 30(7):769\u2013776. https:\/\/doi.org\/10.1089\/lap.2019.0828","journal-title":"J Laparoendosc Adv Surg Tech A"},{"issue":"1","key":"13057_CR7","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10010072","volume":"10","author":"L Dittrich","year":"2020","unstructured":"Dittrich L, Biebl M, Schmuck R et al (2020) Initial experience with the safe implementation of transanal total mesorectal excision (TaTME) as a standardized procedure for low rectal cancer. J Clin Med 10(1):72. https:\/\/doi.org\/10.3390\/jcm10010072","journal-title":"J Clin Med"},{"issue":"2","key":"13057_CR8","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1007\/s10353-019-00626-y","volume":"52","author":"M LabaldeMart\u00ednez","year":"2020","unstructured":"LabaldeMart\u00ednez M, Garc\u00edaBorda FJ, AlcaldeEscribano J et al (2020) Transanal total mesorectal excision and adverse conditions for laparoscopic total mesorectal excision. Eur Surg 52(2):88\u201395. https:\/\/doi.org\/10.1007\/s10353-019-00626-y","journal-title":"Eur Surg"},{"issue":"6","key":"13057_CR9","doi-asserted-by":"publisher","first-page":"zrf111","DOI":"10.1093\/bjsopen\/zraf111","volume":"9","author":"CK Liao","year":"2025","unstructured":"Liao CK, Yu YL, Kuo YT, Hsu YJ, Chern YJ, Lin YC et al (2025) Transanal versus transabdominal total mesorectal excision for rectal cancer in minimally invasive surgery: meta-analysis. BJS Open 9(6):zrf111","journal-title":"BJS Open"},{"issue":"2","key":"13057_CR10","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1097\/SLA.0000000000003757","volume":"274","author":"SX Roodbeen","year":"2021","unstructured":"Roodbeen SX, Spinelli A, Bemelman WA et al (2021) Local recurrence after transanal total mesorectal excision for rectal cancer: a multicenter cohort study. Ann Surg 274(2):359\u2013366. https:\/\/doi.org\/10.1097\/SLA.0000000000003757","journal-title":"Ann Surg"},{"issue":"1","key":"13057_CR11","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1002\/bjs.11459","volume":"107","author":"HH Wasmuth","year":"2020","unstructured":"Wasmuth HH, Faerden AE, Myklebust T\u00c5 et al (2020) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 107(1):121\u2013130. https:\/\/doi.org\/10.1002\/bjs.11459","journal-title":"Br J Surg"},{"issue":"9","key":"13057_CR12","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1002\/bjs.11525","volume":"107","author":"SE van Oostendorp","year":"2020","unstructured":"van Oostendorp SE, Belgers HJ, Bootsma BT et al (2020) Locoregional recurrences after transanal total mesorectal excision of rectal cancer during implementation. Br J Surg 107(9):1211\u20131220. https:\/\/doi.org\/10.1002\/bjs.11525","journal-title":"Br J Surg"},{"issue":"9","key":"13057_CR13","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1007\/s10151-019-02097-5","volume":"23","author":"S Atallah","year":"2019","unstructured":"Atallah S, Sylla P, Wexner SD (2019) Norway versus The Netherlands: will taTME stand the test of time? Tech Coloproctol 23(9):803\u2013806. https:\/\/doi.org\/10.1007\/s10151-019-02097-5","journal-title":"Tech Coloproctol"},{"issue":"5","key":"13057_CR14","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1007\/s00464-010-0965-6","volume":"24","author":"P Sylla","year":"2010","unstructured":"Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205\u20131210. https:\/\/doi.org\/10.1007\/s00464-010-0965-6","journal-title":"Surg Endosc"},{"issue":"1","key":"13057_CR15","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/codi.13151","volume":"18","author":"C Simillis","year":"2016","unstructured":"Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP (2016) A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery? Colorectal Dis 18(1):19\u201336. https:\/\/doi.org\/10.1111\/codi.13151","journal-title":"Colorectal Dis"},{"issue":"2","key":"13057_CR16","doi-asserted-by":"publisher","first-page":"86","DOI":"10.4174\/astr.2021.100.2.86","volume":"100","author":"J Ren","year":"2021","unstructured":"Ren J, Luo H, Liu S, Wang B, Wu F (2021) Short- and mid-term outcomes of transanal versus laparoscopic total mesorectal excision for low rectal cancer: a meta-analysis. Ann Surg Treat Res 100(2):86\u201399. https:\/\/doi.org\/10.4174\/astr.2021.100.2.86","journal-title":"Ann Surg Treat Res"},{"issue":"2","key":"13057_CR17","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.ejso.2020.06.037","volume":"47","author":"OK Ryan","year":"2021","unstructured":"Ryan OK, Ryan \u00c9J, Creavin B et al (2021) Surgical approach for rectal cancer: a network meta-analysis comparing open, laparoscopic, robotic and transanal TME approaches. Eur J Surg Oncol 47(2):285\u2013295. https:\/\/doi.org\/10.1016\/j.ejso.2020.06.037","journal-title":"Eur J Surg Oncol"},{"issue":"9","key":"13057_CR18","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1001\/jama.2024.24276","volume":"333","author":"Z Zeng","year":"2025","unstructured":"Zeng Z, Luo S, Zhang H et al (2025) Transanal vs laparoscopic total mesorectal excision and 3-year disease-free survival in rectal cancer: the TaLaR randomized clinical trial. JAMA 333(9):774\u2013783. https:\/\/doi.org\/10.1001\/jama.2024.24276","journal-title":"JAMA"},{"issue":"5","key":"13057_CR19","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/S2468-1253(26)00022-1","volume":"11","author":"JB Tuynman","year":"2026","unstructured":"Tuynman JB, Yao H, Moolenaar LR et al (2026) Transanal total mesorectal excision versus laparoscopic total mesorectal excision for mid and low rectal cancer (COLOR III): short-term outcomes of an international, multicentre, phase 3, randomised, controlled, non-inferiority trial. Lancet Gastroenterol Hepatol 11(5):355\u2013366. https:\/\/doi.org\/10.1016\/S2468-1253(26)00022-1","journal-title":"Lancet Gastroenterol Hepatol"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-13057-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-026-13057-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-13057-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:17:52Z","timestamp":1789575472000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-026-13057-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":19,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["13057"],"URL":"https:\/\/doi.org\/10.1007\/s00464-026-13057-0","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"assertion":[{"value":"28 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Drs. Chen Su, Junfeng Du, Yang Xie, Xiang Xu, Lanxin Hu, Xuefei Zhang, Yinggang Ge, and Hongyu Zhang have no conflicts of interest or financial ties to disclose.","order":1,"name":"Ethics","label":"Disclosures","group":{"name":"EthicsHeading","label":"Declarations"}}]}}