Background <p>Obesity adds technical complexity to colorectal surgery and has been linked to higher rates of perioperative complications and poorer long-term outcomes. Its prevalence is increasing among patients undergoing minimally invasive total mesorectal excision for rectal cancer; however, its impact on perioperative and oncologic outcomes remains controversial. Therefore, the aim of this study was&#xa0;to compare short- and long-term outcomes between obese (body mass index (BMI) ≥ 27&#xa0;kg/m²) and nonobese patients undergoing minimally invasive total mesorectal excision.</p> Methods <p>Retrospective review of patients with rectal cancer undergoing laparoscopic, robotic, or transanal total mesorectal excision (TME) between January 2015 and December 2022. Propensity score matching (1:1) was performed on baseline characteristics. Primary outcomes included perioperative parameters, postoperative complications, and long-term oncologic outcomes.</p> Results <p>After matching, 142 patients were included in each group. Obesity was associated with higher conversion rates to open surgery (2.8% versus 0%, <i>p = </i>0.044) and increased overall complications (40.1% versus 28.9%, <i>p = </i>0.046), driven mainly by surgical wound infections (9.2% versus 1.4%, <i>p = </i>0.004). No differences were observed in major complications, anastomotic leakage, hospital stay, margin status, or 5-year overall (88% versus 89.4%, <i>p = </i>0.409) and disease-free (62.7% versus 72.5%, <i>p = </i>0.653) survival.</p> Conclusions <p>Obesity increased conversion and minor complication rates but did not adversely affect short-term outcomes or long-term oncologic outcomes after minimally invasive TME procedures. Tailored perioperative strategies may mitigate obesity-associated risks.</p> Trial registration <p>Not applicable.</p>