To compare the clinical efficacy of laparoscopic transanal mesenterectomy (TaTME) and total mesenterectomy (TME) after neoadjuvant treatment for locally advanced rectal cancer.

The clinical data of 72 patients with locally advanced rectal cancer (LARC) who received treatment from January 2020 to December 2022 were retrospectively analyzed. The patients were divided into TaTME group and TME group by random number table method, with 36 patients in each group. All patients underwent laparoscopic surgery after receiving neoadjuvant therapy (NAT) before surgery. The TaTME group underwent laparoscopic TaTME, and the TME group underwent laparoscopic TME. SPSS 22.0 software was used to analyze the data. Perioperative related indicators, fecal incontinence severity (Wexner) score, international prostatic symptoms (IPSS) score and other measurement data were expressed by (), and independent sample t test was used. The statistical data of postoperative complications were represented by [cases (%)] and χ² test was used. Kaplan-Meier method and Log-Rank test were used for survival analysis. P<0.05 indicated that the difference was statistically significant.

Compared with TME group, the operation time, intraoperative blood loss, first anal exhaust time and postoperative hospital stay in TaTME group were significantly reduced (P<0.05), while the integrity of TME specimens was significantly increased (P<0.05). There were no significant differences in the number of lymph nodes dissection, length of distal resection margin, positive rate of CRM and postoperative complications between TaTME group and TME group (P>0.05). Wexner and IPSS scores in TaTME group were significantly lower than those in TME group (P<0.05), while IIEF-5 scores were significantly higher (P<0.05). Kaplan-Meier analysis showed that there was no significant difference in cumulative overall survival (88.9% vs. 83.3%) and cumulative disease-free survival (86.1% vs. 80.6%) between the TaTME group and the TME group (P>0.05).

Compared with laparoscopic TME, laparoscopic TaTME after NAT in LARC patients has achieved better efficacy. On the premise of not affecting the postoperative survival of patients, it shorens the operation time, reduces intraoperative injury, accelerates postoperative recovery, improves the integrity of TME, and significantly improves the anal, prostate and sexual functions.