Objective To analyze perioperative outcomes of rectal cancer patients with different genders undergoing transanal total mesorectal excision (taTME) based on the Chinese taTME Registry Collaborative (CTRC) database.

Methods The retrospective and descriptive study was conducted. Based on concept of real-world research, the clinicopathological data of 1 725 rectal cancer patients who underwent taTME in 36 medical centers, including Beijing Friendship Hospital of Capital Medical University et al, from September 17, 2020 to October 17, 2025 were collected. There were 1 202 males and 523 females, aged 61(range, 50-72) years. Observation indicators: (1) clinicopathological characteristics; (2) surgical and postoperative conditions; (3) postoperative pathological findings. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test.

Results (1) Clinico-pathological characteristics: of 1 725 patients, the body mass index, cases with comorbidities, cases with positive extramural vascular invasion, cases with neoadjuvant therapy were (24±4) kg/m², 387, 229, 609 for male patients with rectal cancer, respectively, versus (23±3) kg/m², 70, 76, 223 for female patients, showing significant differences between them (t=2.96, χ²=74.69, 6.34, 9.08, P<0.05). (2) Surgical and postoperative conditions: of 1 725 patients, the volume of intraoperative blood loss, total operation time, cases with high ligation at the root of inferior mesenteric artery, anastomosis method (stapler anastomosis, manual anastomosis), cases with preventive stoma, and duration of postoperative hospital stay were 50(50,100) mL, (247±87) minutes, 774, 793, 375, 856, and (11±7) days for male patients with rectal cancer, respectively, versus 50(30,100) mL, (223±77) minutes, 299, 371, 134, 312, and (10±5) days for female patients, showing significant differences between them (Z=-4.86, t=5.77, χ²=6.78, 5.17, 23.00, t=2.24, P<0.05). Postoperative complications occurred in 207 male and 72 female patients with rectal cancer, showing no significant difference between them (χ²=3.21, P>0.05). Postoperative anal function assessment was performed in 297 patients (205 males and 92 females). There was no significant difference between male and female patients in no low anterior resection syndrome (LARS), mild LARS, and severe LARS (P>0.05). (3) Postoperative pathological findings: of 1 725 patients, there was no significant difference between male and female patients with rectal cancer in specimen integrity, pathological T staging, pathological N staging, positive circumferential resection margin, positive distal resection margin, maximum tumor diameter, and distance from the tumor inferior margin to distal resection margin (P>0.05).

Conclusions Compared to female patients with rectal cancer, male patients undergoing taTME have higher body mass index, as well as higher proportions of comorbidities, positive extramural vascular invasion, and neoadjuvant therapy. They also have more intraoperative blood loss, longer duration of total operation time, longer postoperative hospital stay, and higher proportions of high ligation at the root of the inferior mesenteric artery and preventive stoma. However, there was no significant difference in the incidence of post-operative complications or anal function between male and female patients.