Abstract: Objective To evaluate the efficacy and safety of transanal total mesorectal excision (TaTME) for the rectal cancer. Methods The databases of Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, VPCS and WanFang Data. All the relevant studies were collected to evaluate the efficacy and safety of transanal total mesorectal excision (TaTME) for the rectal cancer. The quality of the included studies was assessed by the newcastle-ottawa quality assessment scale (NOS). Meta-analysis was conducted by Review Manager 5.3 software. Results 13 studies involving 859 patients were included. In terms of efficacy, Meta-analysis illustrated that TaTME increased the chance of complete resection of the tumor compared with LaTME and reduced the risk of positive circumferential margins. The OR value and 95%CI were (OR = 1.75, 95%CI = 1.02 ~ 3.01, P = 0.040) vs (OR = 0.43, 95%CI = 0.22 ~ 0.82, P = 0.010), respectively. And in terms of safety, the results of Meta analysis showed that the postoperative complications were similar and the risk of lleus and anastomotic leakage was not statistically significant. The Meta-results of them were (OR = 0.91, 95%CI = 0.46 ~ 1.78, P = 0.780) vs (OR = 0.79, 95%CI = 0.45 ~ 1.38, P = 0.400), respectively. Conclusion TaTME had better efficacy than LaTME for the patients with mid- or low-rectal cancer, effectively reducing the incidence of positive peripheral margin. But in terms of safety, there was no significant difference and its authenticity remains more high-quality researches to verify.