taTME offers a preferred option for treating low- and selected mid-rectal cancers in appropriate surgical settings.

• Strong recommendation for taTME over laparoscopic TME (latme) for sphincter-preserving cases.
• High-risk patients, especially males with BMI > 30, may benefit most from this approach.

Surgeons should consider expertise and high-volume centers when making treatment decisions.

• Shared decision-making with patients is crucial for optimal outcomes.