Rectal cancer is one of the frequent malignant neoplasms ,Total mesorectal excision (TME) has become the gold standard treatment for middle and lower rectal cancers. Laparoscopic TME still be difficult in patients with low rectal tumors, narrow pelvic anatomy, male sex or high body mass index . Difficult visualization of the pelvic anatomy along with the limitation of rigid laparoscopic instruments may affect the quality of oncological outcomes and increase the risks of injuries during surgery. A down to up approach via transanal total mesorectal excision (TaTME) technique may overcome these problems

This clinical trial will be conducted at general surgery department of Assiut University Hospital .

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Inclusion Criteria:

• • rectal cancer histologically proven through biopsy

  • tumours located at least 3 cm from anorectal ring;
  • local spread restricted to the rectal wall
  • adequate preoperative sphincter function and continence;
  • absence of distant metastases.
  • Suitable for elective surgical resection

Exclusion Criteria:

• • T4 tumours not responding to neoadjuvant chemo- radiotherapy

  • Patients under 18 years of age
  • Pregnancy
  • Previous rectal surgery (except local excision, endoscopic mucosal resection (EMR) or polypectomy)
  • Patients with acute intestinal obstruction
  • Multiple colorectal tumours
  • Familial Adenomatosis Polyposis Coli (FAP), Hereditary Non-Polyposis Colorectal Cancer (HNPCC), Crohn's disease or ulcerative colitis
  • Planned synchronous abdominal organ resections
  • Preoperative evidence for distant metastases through imaging of the thorax and abdomen
  • Absolute contraindications to general anaesthesia,
  • presence of fecal incontinence,
  • undifferentiated tumors .