Selected early rectal cancers of the mid and distal rectum can be locally excised with preservation of the anal sphincter and avoidance of a permanent colostomy. The transanal technique is better for small tumors of the anterior and lateral rectal side walls, particularly in the distal rectum, while other techniques (i.e. transcoccygeal) are better for lesions that are more proximal or located on the posterior rectal wall. Adjuvant chemoradiation therapy should be used for selected patients (T2or greater). Overall, long-term results appear good for both disease-free survival and function.