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Oibjective: The transanal approach to specimen collection,combined with the prolapsing technique,is a well-established and minimally invasive surgery for treating rectal cancer.However,reports on outcomes for thisapproach are sparse.We compared short-and long-term ourccomes of conventional laparoscopic surgery (CLS) vs.transanal natural orifice specimen extraction (NOSE) using the prolapsing technique for patients with middle-tolow-rectal cancer.Methods: From January 2013 to December 2017,we enrolled consecutive patients with middle-to low-rectalcancer undergoing laparoscopic anterior resection.Totally,50 patients who underwent transanal NOSE using theprolapsing technique were matched with 50 patients who received CLS.Clinical parameters and survival outcomesbetween the two groups were compared.Results: Estimated blood loss (29.70±29.28 vs.52.80±45.09 mL,P=0.003),time to first flatus (2.50±0.79 vs.2.86±0.76,P=0.022),time to liquid diet 0.62±0.64 vs.4.20±0.76 d,P＜0.001),and the need for analgesics (22％ vs.48％,P=0.006) were significantly lower for the NOSE group compared to the CLS group.The incidences ofoverall complications and fecal incontinence were comparable in both groups.After a median follow-up of 44.52months,the overall local recurrence rate (6％ vs.5％,P=0.670),3-year disease-free survival (86.7％ vs.88.0％,P=0.945) and 3-year overall survival (95.6％ vs.96.0％,P=0.708),were not significandy different.Conclusions: For total laparoscopic rectal resection,transanal NOSE using the prolapsing technique is effectiveand safe,and associated with less tauma and pain,a faster recovery,and similar survival outcomes compared toCLS.