Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited. 1 DISEASES OF THE COLON & RECTUM VOLUME 61: 6 (2018) BACKGROUND: Transanal total mesorectal excision is a novel and promising technique in the treatment of low and middle rectal cancer. OBJECTIVE: This study aimed to compare the safety and feasibility of transanal total mesorectal excision versus laparoscopic total mesorectal excision. DESIGN: This was a retrospective study using propensity score matching analysis. SETTINGS: This study was conducted in a single high- volume university hospital. PATIENTS: Patients with low and middle rectal cancer who underwent total mesorectal excision with curative intent between 2007 and 2017 were recruited. INTERVENTIONS: Laparoscopic total mesorectal excision and transanal total mesorectal excision had been performed. MAIN OUTCOME MEASURES: Intraoperative, pathological, and 30-day postoperative outcomes were compared between the transanal and laparoscopic groups. RESULTS: Overall, 105 patients were selected from the whole sample of 316 patients with rectal cancer. After propensity score matching analysis, 46 patients for each group were compared. Laparoscopic total mesorectal excision was associated with a higher conversion rate to open surgery (19.6% vs 0%, p = 0.002). Transanal total mesorectal excision showed a longer distal resection margin (15 mm vs 25 mm; p < 0.001), and similar results regarding the completeness of mesorectal excision and circumferential resection margin involvement, compared to laparoscopy. There were no statistically significant differences between the 2 groups in terms of postoperative complications. LIMITATIONS: The study was limited by its retrospective design and the small size of the sample. CONCLUSIONS: Transanal total mesorectal excision is a safe and feasible technique that results in a high-quality rectal cancer resection specimen and favorable 30-day postoperative outcomes. KEY WORDS: Laparoscopy; Low anterior resection; Propensity score matching; Rectal Cancer; Transanal total mesorectal excision. L ow anterior resection with total mesorectal excision (TME) for middle and low rectal cancers is a techni- cally demanding surgical procedure, and the proc- tectomy is the most challenging step, requiring complex maneuvers to reach the lowest part of the pelvis. Factors such as male sex, high BMI, visceral obesi- ty, a narrow pelvis, and a bulky mesorectum 1 typically Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com). Funding/Support: None reported. Financial Disclosures: None reported. Correspondence: Alberto Biondi, M.D., Polo Scienze Gastroentero- logiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo F. Vito, 1 00168 Rome, Italy. E-mail: alberto.biondi@policlinicogemelli.it Transanal Total Mesorectal Excision vs Laparoscopic Total Mesorectal Excision in the Treatment of Low and Middle Rectal Cancer: A Propensity Score Matching Analysis Roberto Persiani, M.D. • Alberto Biondi, M.D. • Francesco Pennestrì, M.D. Valeria Fico, M.D. • Veronica De Simone, M.D. • Flavio Tirelli, M.D. Francesco Santullo, M.D. • Domenico D’Ugo, M.D. Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario Agostino Gemelli Largo F. Vito, Rome, Italy Dis Colon Rectum 2018; 61: 00–00 DOI: 10.1097/DCR.0000000000001063 © The ASCRS 2018 DYNAMIC ARTICLE