PURPOSE:The aim of the study is to outline the rising importance of local treatment of rectal tumors and a changing strategy in therapy of early rectal cancer.METHODS:As the surgical procedure, transanal endoscopic microsurgery was used. Indications for the local procedure were pT1 low‐risk tumors and tumors of higher stages in patients with severe risk factors and of those who refused the operation according to oncologic guidelines.RESULTS:A total of 236 rectal adenomas and 98 carcinomas were locally excised using the transanal endoscopic microsurgery technique. Mortality rate was 0.3 percent, and rate of complications requiring surgical reintervention was 5.5 percent in adenomas and 8 percent in carcinomas. Final histology of removed carcinomas revealed 56 pT1, 27 pT2, and 15 pT3 stages. After an average follow‐up time of 24 months, two recurrences were observed in the group of patients with pT1 low‐risk carcinomas who only underwent local therapy. In both cases, a second intervention for cure was undertaken but for tumors in a late stage.CONCLUSIONS:In selected cases, local therapy of rectal carcinoma avoids high morbidity and mortality of the classical operation. Quality of life will be improved, especially if an artificial anus can be avoided. In case of recurrence, the chance of a secondary procedure for cure is not to be underestimated.