Introduction The use of transanal endoscopic microsurgery (TEMS) for the resection of benign rectal lesions is well established; its role in the management of carcinoma is less well defined. With the advent of the Bowel Cancer Screening Programme the incidence of early rectal cancer is increasing. Here we describe our experience of 25 cases undergoing TEMS resection for cancer.

Methods An electronic database was used to identify the outcomes of patients undergoing TEMS procedures; operation and anaesthetic notes and original pathology reports were reviewed. Patients underwent TEMS if preoperative staging was limited to early uT1 disease or in more advanced disease where patients were not deemed fit for an anterior resection.

Results 25 patients were included, (16 male 9 female), mean age was 69. ASA grade I,2; II,11 and III,12. Patients underwent preoperative staging with endoanal ultrasound and/or MRI. 20 patients were staged as uT1, four patients as uT2 and one patient as uT2/3 N1. In seven cases the lesion was located in the lower rectum and in 18 in the mid or upper third. Full thickness resections were performed in 22 patients with resection in the submucosal plane in three. Full thickness defects were closed in all cases. The mean size of specimen was 9 cm² (95% CI 3.5 to 14.5 cm². Histopathology revealed that two patients had been understaged; both had pT2 N0 disease; one underwent anterior resection and one declined further surgery. All but two patients had R0 resections and one patient with a pT1 R0 resection developed recurrent disease. Mean operating time was 110 min (95% CI 92 to 128) and median length of stay was 3 days (range 2–15 days). Four patients had complications; two patients bled post-operatively, one requiring re-operation, one patient developed post-operative emphysema and one a recto-vaginal fistula.

Conclusion Our series demonstrates that TEMS is a useful technique for the resection of uT1 disease though is not without complication. Where pT1 SM3 or more advanced disease is present anterior resection is advised.