AIM A systematic review of the literature was performed to evaluate the quality of the current body of evidence on transanal total mesorectal excision(TaTME).METHODS MEDLINE,PubMed,EMBASE,Google Scholar,and The Cochrane Library were systematically searched through April 2nd,2016.RESULTS The literature search identified 47 relevant studies with 985 patients operated on TaTME for rectal cancer.The conversion rate was estimated at 2.44%.The cumulative morbidity rate was 30.97%and the 30-day operative mortality 0.21%.A complete mesorectum(grade Ⅲ)was achieved in 87.96%of TaTME cases.Pooled analyses of 10 comparative studies suggested that,compared to laparoscopic total mesorectal excision(LaTME),TaTME was associated with significantly less conversion rate(Odds Ratio(OR)0.24(95%confidence interval(CI)0.10,0.55); P = 0.04),higher TME specimen completeness rate(OR 1.92(95%CI 1.03,3.60); P = 0.02),and lower circumferential margin(CRM)positivity rate(OR 0.34(95%CI 0.16,0.73); P = 0.006).Operative time of TaTME was 20.03 min(95%CI-34.43,-5.63; P = 0.006)shorter than that of LaTME.Distal resection margins were comparable between the two groups(mean difference 3.47 mm(95%CI-0.95 mm,7.90 mm); P = 0.12).Comparable incidence of anastomotic leakage or abscess(OR 0.66(95%CI 0.35,1.23); P = 0.19)was observed.CONCLUSION TaTME appears to be safe and feasible,probably with better pathological outcomes compared to LaTME.Randomized controlled clinical trials are required before TaTME can be widely recommended for low rectal cancer.