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To evaluate the efficacy of laparoscopy combined with transanal endoscopic microsurgery (TEM) in the treatment of rectal cancer.A total of 60 rectal cancer patients who underwent radical resection from December 2009 to December 2013 were enrolled in this study. All patients were randomly divided to receive either laparoscopic surgery (LA group) or laparoscopy combined with TEM (LT group). Demographics including age and sex, and tumor characteristics including tumor size, distance from anal verge, and preoperative staging were all recorded. The operation time, hospital stay, cases with intraoperative blood transfusion, the number of resected lymph node, postoperative out-of-bed activity, passage of gas by anus, fasting time, and postoperative complications were assessed.Compared with the LA group, patients in the LT group had shorter operation time (118.5±22.0 vs. 138.1±23.8 min, P=0.002), earlier out-of-bed activity (60.4±19.2 vs. 83.6±9.6 h, P=0.001) and passage of gas by anus (81.4±5.4 vs. 86.2±8.7 h, P=0.013), and shorter hospital stay (8.0±2.8 vs. 11.0±3.5 d, P=0.001). Patients were followed up for a median time of 28 months (range, 3 to 48 mo). No local recurrence and distant metastasis occurred in all cases.Laparoscopy combined with TEM is a feasible and effective treatment for radical excision of middle-upper rectal cancer due to the advantages of lower morbidity and earlier recovery.