The goal of this review is to investigate at the oncological safety of TaTME after excision of low and medium rectal tumors, as well as the early detection of postoperative complications such sepsis, anastomotic leakage, fistula, stenosis, and recurrence. A sum of 40 participants with middle and low rectal cancer participated in this study. These patients were managed in Elsayyed Galal Hospital by transanal total mesorectal excision (TaTME). Among 40 included cases average age was 55.87 years with male predominance in 70% and average BMI was 28.18, average distance from AV was 7.13, intraoperative complications founded in 7.5% of cases in form of bleeding in 5% and ureter\urethra injury in 2.5% and 92.5% had no complications, and there were no patients who needed to be converted to an open procedure., postoperative complications was pelvic abscess in 20% of cases, left colon necrosis in 5% , ileus in 27.5% , fistula in 22.5% , anastomotic leak in 5% and fever, UTI in 20%, 90% of cases show no local recurrence and 10% of cases show local recurrence, and 5% of cases had distant recurrence. Transanal total mesorectal surgery was performed successfully and showing promise in improving oncological outcomes in advanced rectal cancer patients. This approach offers a lot of potential benefits and might be used to treat rectal tumor.