ObjectiveTo evaluate the short-term clinical outcomes of transanal total mesorectal excision (TaTME) for mid-to-lower rectal cancer and provide evidence for clinical decision-making. MethodsThe relevant literature from domestic and international databases in recent years was reviewed to systematically assess the current application of TaTME in the treatment of mid-to-low rectal cancer. A comparative analysis was conducted between the TaTME and laparoscopic total mesorectal excision (LapTME), focusing on intraoperative outcomes, short-term postoperative recovery, intraoperative and postoperative complications, oncological prognosis, and the learning curve. ResultsConventional LapTME presented significant challenges in performing precise maneuvers within the pelvis and around the rectum, particularly in patients with “difficult pelvis” characteristics such as obesity, narrow pelvis, or male anatomy. In contrast, TaTME demonstrated certain advantages, including improved visualization of anatomical planes, reduced intraoperative bleeding, lower conversion rate to open surgery, faster short-term postoperative recovery, and enhanced specimen quality. ConclusionTaTME is a safe procedure with short-term outcomes, which is superior or comparable to those of laparoscopic surgery, offering a new surgical option for the treatment of mid-to-lower rectal cancer.