Although longer term follow up is still required, TEM appears to be an effective method of excising benign tumours and T1 carcinomas of the rectum. The role of TEM in the treatment of T2 carcinomas is, as yet, unclear and needs further evaluation although the results of our series and others are encouraging.

This is one of the largest series of rectal cancers from a single NHS trust. We have demonstrated that age, Dukes' stage and CRM status are associated with long-term survival. These clinical factors are readily available to the surgeon at the time of first post-operative review and can provide a good clinical guide to prognosis.

Plasma big ET-1 appears to have no prognostic value in primary CRC.

Significant advances have been made recently in the management of patients undergoing colorectal surgery. demonstration of the advantages of laparoscopic colorectal surgery over the open approach in terms of faster patient recovery, shorter length of hospital stay, less pain and fewer wound problems with identical oncological outcome has led to the widespread adoption of the technique. Simultaneously, based on the original work of Kehlet, enhanced recovery after surgery (ERAS) programmes that capitalise on the reduced physiological insult stimulated by laparoscopic surgery have gained in popularity. Coupled, laparoscopic surgery and ERAS allow many patients undergoing major colorectal resections to be discharged from hospital on the first to third post-operative day.