Objective  The long‐term results are presented on total survival, cancer‐specific survival and recurrence in 143 consecutive patients treated with transanal endoscopic microsurgery (TEM) for adenocarcinoma of the rectum.

Method  Four Danish centres established in 1995 a database for registration of all TEM procedures. Data were supplemented from pathology reports and death certificates were checked in the Danish patient registry. Data were analysed with multivariance regression and survival analysis.

Results  The T stage was as follows: T1 50%, T2 33%, T3 14%, and stage unknown 3%. TEM was performed with curative intent in 43%, for compromise in 52% and for palliation in 5%. Five‐year total survival was 66% and 5‐year cancer‐specific survival 87%. Cancer‐specific survival for T1 was 94%. The significant predictors for total survival were age and tumour size. For cancer‐specific survival T stage, radical resection, tumour size and recurrence were significant predictors. Eighteen per cent had recurrence and 15% had immediate reoperation.

Conclusion  The TEM provides good long‐term results for pT1 cancers. In old patients and patients with co‐morbidity TEM may provide acceptable long‐term results for T2 cancers. Tumours larger than 3 cm should not be treated with TEM for cure.