After Heald’s revolution in 1982, who introduced the Total Mesorectal Excision, for improve the results in terms of recurrance and survival rate, there is a need to explore new therapeutic options in treatment of sub-peritoneal rectal cancer. In particular, local excision represent more often a valid technique for non advanced rectal cancer treatment in comparison with the more invasive procedure, especially in elderly and/or in poor health patients. The introduction of TEM by Buess (Transanal endoscopy Microsurgery), has extended the local treatment also to classes of patients who would normally have been candidates for TME. The author gives literature’s details and his experience in the use of TEM for early rectal cancer sub-peritoneal. The aim of the study is to analyze short and long term results in terms of local recurrence and survival rate comparing TEM technique with the other transanal surgery in rectal cancer treatment. Preoperative Chemio-Radio therapy and rigorous Imaging Staging are the first steps to planning surgery. It’s time, for local rectal cancer, has come to make the devolution a few decades ago has been accomplished in the treatment of breast cancer