Background: Rectal cancer is the third most common cancer in men and fourth in women, with surgical resection being the primary treatment. Recent advances have introduced laparoscopic techniques, which may offer improved outcomes compared to traditional open surgery. Objectives: This study aims to compare surgical, oncological, and pathological outcomes of open versus laparoscopic total mesorectal excision (TME) for rectal cancer. Methods: A prospective comparative study was conducted at the General Surgery Department of Benha University involving 60 patients scheduled for rectal cancer surgery from September 2022 to September 2024. Patients were divided into two groups: Group A (open surgery) and Group B (laparoscopic surgery). Key perioperative data, pathology results, and postoperative recovery metrics were collected and analyzed. Results: The mean age was 65.0 years for Group A and 62.6 years for Group B (p=0.288). Laparoscopic surgery significantly reduced blood loss (400.5 ml vs. 840.0 ml; p