Objective:To compare the efficacy and safety of transanal endoscopic microsurgery(TEM)and traditional transanal excision(TAE)for rectal neoplasms. Methods:Randomized controlled trials(RCTs)or comparative studies comparing TEM with TAE for rectal neoplasms published from 1990 to 2015 were searched in Pubmed

Embase

The Cochrane Library and China National Knowledge Infrastructure(CNKI)

Wanfang Data. Review manager 5.3 was used for Meta-analysis and postoperative complication rate

negative microscopic margins

specimen fragmentation and lesion recurrence were analyzed and compared. Results:A total of 6 studies including 927 patients were identified and analyzed. The results showed no significant difference in the postoperative complication rate(RR=0.92

95%CI=0.65 to 1.31

P=0.660). The rate of negative microscopic margins was higher in TEM(RR=1.30

95%CI=1.06 to1.58

P=0.010). However

specimen fragmentation(RR=0.16

95%CI=0.08 to 0.29

P=0.000)and lesion recurrence(RR=0.32

95%CI=0.22 to 0.46

P=0.000)were more frequently observed in TAE group. Conclusion:TEM is superior to TAE in increasing negative microscopic margins and reducing specimen fragmentation and lesion recurrence.