taTME shows promising long-term outcomes for low rectal cancer patients, crucial for surgical practice.

• Three-year overall survival was 93.7%, with disease-free survival at 84.6%.
• Late complications in 32 patients, with 21 classified as severe; one required surgical revision.

Surgery can prioritize sphincter preservation without compromising oncologic outcomes.

• 97% of patients were stoma-free at three years, highlighting successful functional results.