**5.2 Selected T1 rectal adenocarcinomas**

In case of rectal cancer, a number of factors should be considered to set the indications for tumor excision by TEM. These factors include physical examination findings, preoperative imaging, and histopathological characteristics [20–22].

Preoperative staging examinations include:


Several studies concluded that in carefully selected low-risk T1 patients, TEM had a similar local recurrence rate than total mesorectal excision [23]. Criteria to set the indications for tumor excision by TEM are summarized in **Table 1**.

TEM and TAMIS are also effective for patients' management after R1 polypectomy, after either EMR or ESD [24], avoiding total mesorectal excision, which would be an overtreatment. The oncological outcomes of transanal minimally invasive procedures in these patients are equal to more invasive surgery, with R0 status in all cases, low morbidity, and 0% mortality rate at a minimum 12 months follow-up [19].
