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Transanal endoscopic microsurgery (TEM) is a well-established treatment of T1 carcinomas of the rectum. EPMR (endoscopic posterior mesorectal resection) makes it possible to remove the mesorectum minimally invasively. The aim of this study was to determine the safety and efficacy of TEM + EPMR.Eight patients with T1 carcinomas of the rectum were operated upon using TEM + EPMR as a two-stageprocedure.It was possible to perform a complete excision of the tumour and the mesorectum in all cases. There were no intraoperative complications' apart from one rectum perforated during EPMR which was treated with additional sutures. Postoperative morbidity consisted of one hematoma which resolved without any additional treatment. Histological analysis revealed a median yield of eight (5- 12) lymph nodes. After a median follow-up of 16 (4-32) months, there was no evidence of locoregional recurrence. There were no differences in manometry and also fecal continence control assessed using FISIpre-and postoperatively apart from one woman with gas incontinence, who was diagnosedpreoperatively.EPMR in combination with TEM permits a locally radical operation and adequate tumour staging in T1 carcinomas of the rectum. TEM + EPMR does not affect basic anorectal function. However, further studies on a larger group with a longer follow-up are needed.