A multicenter clinical study on transanal endoscopic sphincter-preserving resection of low rectal tumors.

Introduction: Transanal Endoscopic Sphincter-Preserving Resection (TA-ESPR) is a super-minimally invasive endoscopic technique for digestive tract tumors. This study aimed to evaluate the feasibility, safety, and clinical efficacy of TA-ESPR in patients with low rectal tumors-including elderly individuals with severe comorbidities, postoperative recurrent cases, radiotherapy-resistant residual tumor patients, and those refusing conventional surgery to preserve anal function-and to provide an ultra-minimally invasive treatment option for this patient population. Methods: A retrospective case series study was conducted. Thirty-seven patients with rectal tumors who underwent TA-ESPR and completed regular follow-up between June 2020 and January 2025 were enrolled from two tertiary medical institutions. All patients declined radical surgery and opted for TA-ESPR after full informed consent; postoperative management was guided by histopathological results. Results: Among the 37 patients, 73% had low-grade rectal cancer, 16.2% had neuroendocrine tumors, and 10.8% had stromal tumors. The en bloc resection rate and complete resection rate both reached 100%, with no severe adverse events. The mean follow-up duration was 36.86 ± 16.71 months (as of November 1, 2025), and the recurrence rate was 2.7%. Conclusion: TA-ESPR is a safe and effective treatment for low rectal tumor patients with clinical dilemmas. It effectively preserves anal function, improves postoperative quality of life, and serves as a preferred treatment with important clinical value.