关键词: 经肛全直肠系膜切除, 困难骨盆, 局部复发, 肿瘤安全性

Abstract: The value and controversy of transanal total mesorectal excision        ZHANG Hong, CONG Jin-chun. Department of Colorectal Tumor Surgery, Shengjing Hospital, China Medical University, Shenyang 110004,China
Corresponding author: ZHANG Hong, E-mail：haojiubujian1203@sina.cn
Abstract    The original intention and expected benefit of transanal total mesorectal excision（taTME）intended is to gain better oncology results in the low and middle rectal cancers with difficult pelvis.But this technology，which has been carried out for a decade，is still in controversy，with issues ranging from technical safety to tumor safety.The focus issues mainly include questions about the necessity of performing taTME surgery，whether taTME has the advantage in the circumferential resection margin，whether taTME increases the risk of local recurrence，and whether taTME increases the complications.TaTME's technical safety can be improved through structured training，but specific intraoperative and postoperative complications remain.Although the safety of taTME's tumors has been shown to be non-inferior in some studies，the impact of Norway's decision to suspend taTME surgery has come under renewed scrutiny.The advantages of taTME in low and middle rectal cancer with a difficult pelvis still await high-quality evidence-based medical evidence.TaTME's values and controversial issues need to be evaluated objectively and fairly，with neither adulation nor denial.

Key words: transanal total mesorectal excision, difficult pelvis, local recurrence, tumor safety