Objective:

To evaluate the oncologic outcomes of one-team TaTME compared with LapTME in patients with mid and low rectal cancer treated under routine clinical practice conditions.

Approach:

• Study Design: A single-center retrospective cohort study was conducted, analyzing patients undergoing curative TME for rectal adenocarcinoma from January 2018 to May 2022.
• Patient Selection: Inclusion criteria included histologically confirmed mid- or low rectal adenocarcinoma, clinical stage cT1–T3, NO–N2 (M0), and age ≥ 18 years. Exclusion criteria included tumor invasion requiring abdominoperineal resection and severe organ dysfunction.
• Surgical Techniques: Patients were categorized into TaTME or LapTME groups, with TaTME performed using a single-team sequential approach.
• Data Collection: Clinical and pathological data were extracted from electronic medical records, including baseline variables, intraoperative data, and pathological outcomes.
• Outcome Definitions: Primary outcomes included 3-year local recurrence and distant metastasis rates, while secondary outcomes included disease-free survival and overall survival.
• Statistical Analysis: Propensity score matching was utilized to adjust for baseline differences between the TaTME and LapTME groups.

Key Findings:

• TaTME demonstrated comparable oncologic outcomes to LapTME in terms of local recurrence and distant metastasis rates.
• The study highlighted the importance of surgical expertise and standardization in achieving optimal outcomes.
• Findings indicate that TaTME can be implemented in routine clinical practice under single-team workflows.

Interpretation:

The study provides insights into the feasibility and outcomes of TaTME compared to LapTME in standard clinical settings.

Limitations:

• The study is retrospective and conducted at a single center, which may limit generalizability.
• Potential biases related to non-random treatment assignment despite propensity score matching.

Conclusion:

The findings support the oncologic safety of TaTME in routine practice.