Background and Aims Although the laparoscopic total mesorectal excision (LaTME) has been widely used in the treatment of rectal cancer, it still has technical obstacles. Transanal total mesorectal excision (TaTME) can overcome the limitations of LaTME and has certain advantages in the treatment of middle and low rectal cancer. However, there is still controversy over the efficacy and safety of TaTME. Therefore, this study was conducted to compare the short-term efficacy and safety of TaTME and LaTME through Meta, so as to provide evidence-based information for clinical decision-making.Methods The studies comparing TaTME and LaTME in the treatment middle and low rectal cancer were collected by searching several national and international online databases. After data extraction and quality evaluation of the included studies, Meta-analysis was performed using RevMan5.3 software.Results A total of 18 controlled studies were included, involving 2 334 patients with 1 133 cases in TaTME group and 1 201 cases in LaTME group. The results of Meta-analysis showed that the rate positive circumferential resection margin (CRM) (OR=0.58, 95% CI=0.40-0.83, P=0.003), open conversion rate (OR=0.18, 95% CI=0.11-0.31, P<0.000 01), length of hospital stay after surgery (WMD=-1.51, 95% CI =-2.70--0.33, P=0.01), and R₁ resection rate (OR=0.30, 95% CI=0.15-0.60, P=0.000 7) were reduced in TaTME group compared with LaTME group; there were no significant differences in terms of the number of harvested lymph nodes, operative time, blood loss, completeness of mesorectal excision, CRM distance, rate of positive distal resection margin (DRM), DRM distance, and incidence rates of anastomotic leakage and intestinal obstruction (all P>0.05).Conclusion Under strict surgical indications, the safety of TaTME is not inferior to that of LaTME in the treatment of middle and low rectal cancer, and it also can achieve better oncological outcomes. However, the above conclusion still needs to be further verified by including more high-quality studies.