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Laparoscopic surgery has yet to achieve widespread acceptance for the treatment of rectal cancer because of technical difficulty caused by anatomical features and the lack of sufficient evidence supporting effectiveness. Consequently, the safety and long-term outcomes of laparoscopic surgery for rectal cancer remain to be established in Japan. We evaluated the feasibility, safety, and effectiveness of laparoscopic surgery in patients with up to clinical stage 0/I rectal cancer.From February 1998 through December 2010, we studied 137 patients with up to clinical stage 0/I rectal cancer treated by laparoscopic surgery. Surgical outcomes, invasiveness, safety, recurrence rates and patterns, and medium-term outcomes were examined. Four patients were converted to open surgery and excluded from analysis.The median follow-up was 64 months (range, 9 to 156 mo), and the rate of conversion to open surgery was 2.8% (4/141). Postoperative complications occurred in 37 patients (27%) and included anastomotic leakage in 10 patients (10/125, 7.9%) and ileus in 10 patients (10/37, 7.3%). The recurrence rate was 6.6%. Lung metastasis and liver metastasis were frequent, but no patient had port-site recurrence. The 5-year disease-free survival rate and the cumulative survival rate were 94.2% and 96.9%, respectively, in patients with stage I disease and 80.2% and 94.7% in those with stage III disease.Laparoscopic resection had good surgical outcomes, minimal invasiveness, high safety, and high rates of disease-free survival and overall survival in patients with up to clinical stage 0/I rectal cancer. These results suggest that laparoscopic surgery is a safe and effective procedure for the management of rectal cancer with clinical stage 0/I.