Extending the role of Transanal Endoscopic Microsurgery (TEM) in rectal cancer

Increasingly it is becoming clear that there is a role for local excision of early rectal cancer by Transanal Endoscopic Microsurgery (TEM) as part of an organ-preservation strategy. This role is based on careful preoperative assessment, thorough postoperative histopathological examination and standardized follow up, with recourse to completion or salvage radical surgery in the face of poor prognostic factors, or early concerns over recurrent disease. Additionally, TEM is also proposed in selected circumstances after neoadjuvant treatment for rectal cancer. This latter topic is even more controversial with clinical evidence still evolving, but specialist centres report impressive results that cannot be ignored in the modern management of rectal cancer.