Supplement Table 1. Quality assessment of the included retrospective case series and comparative case-control studies (NOS Scale). Criteria Selection Comparability Study Exposure / Overall Outcome Score Dumont et al 2012[1] ★★ - ★ 3/9 Sylla et al 2013[2] ★★ - ★ 3/9 Lacy et al 2013[3] ★★ - ★ 3/9 Rouanet et al 2013[4] ★★ - ★ 3/9 deLacy et al 2013[5] ★★ - ★ 3/9 Wolthuis et al 2014[6] ★★ - ★ 3/9 Atallah et al 2014[7] ★★ - ★ 3/9 Chouillard et al 2014[8] ★★ - ★ 3/9 ★ - ★ 2/9 Zorron et al 2014[10] ★★ - ★ 3/9 Atallah et al 2014[11] ★★ - ★ 3/9 Velthuis et al 2014[12] ★★★ ★ ★ 5/9 Tuech et al 2015[13] ★★ - ★ 3/9 Gomez Ruiz et al 2015[14] ★★ - ★ 3/9 Knol et al 2015[15] ★★ - ★ 3/9 Serra Aracil et al 2015[16] ★★ - ★ 3/9 Huscher et al 2015[17] ★★ - ★ 3/9 Veltcamp Helbach[18] ★★ - ★ 3/9 Muratore et al 2015[19] ★★ - ★ 3/9 Elmore et al 2015[20] ★★ - ★ 3/9 Chen et al 2015[21] ★★ - ★ 3/9 ★★★ ★ ★ 5/9 Meng et al 2014[9] Fernandez-Hevia et al 2015[22] 1 1. Dumont F, Goere D, Honore C, Elias D (2012) Transanal endoscopic total mesorectal excision combined with singleport laparoscopy. Diseases of the colon and rectum 55 (9):996-1001. doi:10.1097/DCR.0b013e318260d3a0 2. Sylla P, Bordeianou LG, Berger D, Han KS, Lauwers GY, Sahani DV, Sbeih MA, Lacy AM, Rattner DW (2013) A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surgical endoscopy 27 (9):3396-3405. doi:10.1007/s00464-013-2922-7 3. Lacy AM, Adelsdorfer C, Delgado S, Sylla P, Rattner DW (2013) Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study. Surgical endoscopy 27 (1):339-346. doi:10.1007/s00464-012-2443-9 4. Rouanet P, Mourregot A, Azar CC, Carrere S, Gutowski M, Quenet F, Saint-Aubert B, Colombo PE (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Diseases of the colon and rectum 56 (4):408-415. doi:10.1097/DCR.0b013e3182756fa0 5. de Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernandez M, Delgado S, Sylla P, Martinez-Palli G (2013) Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: "down-to-up" total mesorectal excision (TME)--short-term outcomes in the first 20 cases. Surgical endoscopy 27 (9):3165-3172. doi:10.1007/s00464013-2872-0 6. Wolthuis AM, de Buck van Overstraeten A, D'Hoore A (2014) Dynamic article: transanal rectal excision: a pilot study. Diseases of the colon and rectum 57 (1):105-109. doi:10.1097/DCR.0000000000000008 7. Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, Larach S (2014) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Techniques in coloproctology 18 (5):473-480. doi:10.1007/s10151-013-1095-7 8. Chouillard E, Chahine E, Khoury G, Vinson-Bonnet B, Gumbs A, Azoulay D, Abdalla E (2014) NOTES total mesorectal excision (TME) for patients with rectal neoplasia: a preliminary experience. Surgical endoscopy 28 (11):3150-3157. doi:10.1007/s00464-014-3573-z 9. Meng W, Lau K (2014) Synchronous laparoscopic low anterior and transanal endoscopic microsurgery total mesorectal resection. Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy 23 (2):70-73. doi:10.3109/13645706.2014.887022 10. Zorron R, Phillips HN, Wynn G, Neto MP, Coelho D, Vassallo RC (2014) "Down-to-Up" transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients. Journal of minimal access surgery 10 (3):144-150. doi:10.4103/0972-9941.134878 11. Atallah S, Martin-Perez B, Parra-Davila E, deBeche-Adams T, Nassif G, Albert M, Larach S (2015) Robotic transanal surgery for local excision of rectal neoplasia, transanal total mesorectal excision, and repair of complex fistulae: clinical experience with the first 18 cases at a single institution. Techniques in coloproctology. doi:10.1007/s10151-015-1283-8 12. Velthuis S, Nieuwenhuis DH, Ruijter TE, Cuesta MA, Bonjer HJ, Sietses C (2014) Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surgical endoscopy 28 (12):3494-3499. doi:10.1007/s00464-014-3636-1 13. Tuech JJ, Karoui M, Lelong B, De Chaisemartin C, Bridoux V, Manceau G, Delpero JR, Hanoun L, Michot F (2015) A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Annals of surgery 261 (2):228-233. doi:10.1097/SLA.0000000000000994 14. Gomez Ruiz M, Parra IM, Palazuelos CM, Martin JA, Fernandez CC, Diego JC, Fleitas MG (2015) Roboticassisted laparoscopic transanal total mesorectal excision for rectal cancer: a prospective pilot study. Diseases of the colon and rectum 58 (1):145-153. doi:10.1097/DCR.0000000000000265 15. Knol JJ, D'Hondt M, Souverijns G, Heald B, Vangertruyden G (2015) Transanal endoscopic total mesorectal excision: technical aspects of approaching the mesorectal plane from below-a preliminary report. Techniques in coloproctology 19 (4):221-229. doi:10.1007/s10151-015-1275-8 16. Serra-Aracil X, Mora-Lopez L, Casalots A, Pericay C, Guerrero R, Navarro-Soto S (2015) Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis. Surgical endoscopy. doi:10.1007/s00464-015-4170-5 17. Huscher CG, Bretagnol F, Ponzano C (2015) Robotic-assisted transanal total mesorectal excision: the key against the achilles' heel of rectal cancer? Annals of surgery 261 (5):e120-121. doi:10.1097/SLA.0000000000001089 18. Veltcamp Helbach M, Deijen CL, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C (2015) Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surgical endoscopy. doi:10.1007/s00464-015-4221-y 19. Muratore A, Mellano A, Marsanic P, De Simone M (2015) Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results. European journal of surgical oncology : the journal of the 2 European Society of Surgical Oncology and the British Association of Surgical Oncology 41 (4):478-483. doi:10.1016/j.ejso.2015.01.009 20. Elmore U, Fumagalli Romario U, Vignali A, Sosa MF, Angiolini MR, Rosati R (2015) Laparoscopic anterior resection with transanal total mesorectal excision for rectal cancer: preliminary experience and impact on postoperative bowel function. Journal of laparoendoscopic & advanced surgical techniques Part A 25 (5):364-369. doi:10.1089/lap.2014.0435 21. Chen CC, Lai YL, Jiang JK, Chu CH, Huang IP, Chen WS, Cheng AY, Yang SH (2015) The evolving practice of hybrid natural orifice transluminal endoscopic surgery (NOTES) for rectal cancer. Surgical endoscopy 29 (1):119-126. doi:10.1007/s00464-014-3659-7 22. Fernandez-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Diaz del Gobbo G, DeLacy B, Balust J, Lacy AM (2015) Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Annals of surgery 261 (2):221-227. doi:10.1097/SLA.0000000000000865 3