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Gasless transanal endoscopic surgery (GTES) allows to excise rectal tumors using laparoscopic tools via operative rectoscope. Evaluation of effectiveness of GTES for Tis-1 N0 M0 G1-2 rectal carcinomas (< 3 cm) was the aim of the study.Between 1999 and 2010, 67 patients (32 male) [mean age 64.4 (range, 49-86)] with early rectal cancer underwent GTES. Mean size of lesions was 2.7 ± 0.9 cm (0.8-6.0) at a mean distance from dental line of 6.9 ± 1.7 cm (1.0-11.0).There were no conversions to major surgery. The median operating time and blood loss were 58 (25-120) min and 35 (0-180) ml, respectively. Postoperative morbidity rate was 4/67 (5.9%). There was 1.4% mortality. Pathological examination revealed 12 Tis, 35 T1G1-2, 2 T1G3, 7 T2G1-2 and 1 T3G3. Six patients with pT2 carcinomas underwent postoperative EBRT (45 Gy). At mean follow up of 24.3 ± 11.2 months (4-109), local recurrence developed in 2 (5%). One was salvaged by APE and was alive at 28 months, another 82-old man further from refused treatment and died within 4 months.GTES is safe, effective and simple surgicalprocedure for patient with early rectal carcinomas.