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Introduction of transanal endoscopic microsurgery (TEM) has intensified interest in the treatment of benign and malignant rectal tumours. TEM experience has largely been reported from specialist centres. The aim of this study was to review our experience of TEM within a non-academic surgical unit.Aprospectively collected database between September 1995 and November 2009 of TEM excisions for benign and malignant rectal tumours was analysed.Two hundred and forty-seven TEM excisions were performed in 236 patients, 187 (75.7%) resections for adenomas and 60 (24.3%) for carcinomas. Patients with benign and malignant tumours were similar with respect to age and gender distribution. Commonest complications included bleeding 8 (3.3%), perforation 5 (2.3%) and thromboembolic events in 2 (0.8%) cases. The 30-day mortality was 0.8%. In the adenoma group local recurrence occurred in 9 (4.8%) patients. In the carcinoma group, 21/59 (35.5%) patients had neoadjuvant chemoradiation. 11/59 (18.6%) patients required radical surgery following TEM due to poor histologicalprognosis. In the remaining 48/59 (81.4%) patients with a median follow up of 13 ± 6 months, 3/48 (6.1%) patients had local recurrence and 1/ 48 (2%)presented with liver metastases.TEM resections have increased in our unit. Our results show that TEM has comparable morbidity, mortality and recurrence rates to TEM experience reported in specialist centres.