Transanal total mesorectal excision (TATME) shows promising long-term results for patients with low rectal cancer.

• Three-year overall survival at 93.7%, disease-free survival at 84.6%.
• 97% of patients remained stoma-free at 3 years, enhancing quality of life.

Consider TATME for resectable mid and low rectal tumors; ongoing monitoring of long-term outcomes remains essential.

• Significant late complications in 32% of patients, with 21 classified as severe (Clavien-Dindo ≥3).
• Recurrence linked to preoperative N stage, lymph node yield, tumor deposits, and perineural invasion.