[Transanal total mesorectal excision for low rectal cancer: pros and cons]

Colorectal cancer is the 3rd most commonly diagnosed cancer, with rectal cancer specifically accounting for 1/3 of new cases. Despite advances in care, there is still a lack of standardization in diagnosis, staging, and treatment, with associated high rates of positive margins, recurrence, and mortality. The gold standard for curative resection remains a total mesorectal excision(TME), and the quality of the TME is one of the most important prognostic factors for local recurrence. The proper TME specimen with negative resection margins is inherently challenging due to patient and tumour-related factors. These difficulties have not been overcome with the laparoscopic approach. Transanal TME (taTME) is an innovative surgical technique developed to overcome the limitations in exposure and instrumentation in low pelvic surgery by approaching the rectum from below. Interest in taTME continues to grow worldwide, and structured training programs and case registries have been developed to aid safe implementation of this new technique in clinical practice. As the utilization of taTME and indications for the procedure continue to expand, structured programs to standardize teaching, training, and safe expansion will aid the safe spread of the taTME technique. With the growing popularity, a review of the pros and cons of the taTME is timely.