Introduction 1 3 1 4 5 9 10 13 14 16 17 18 Quality of life is increasingly recognised as the ultimate endpoint when assessing clinical outcomes after different surgical interventions because it measures the patient’s perspective. The precise impact of the TEM procedure on quality of life has not been well studied. This prospective study was set out to provide a comprehensive insight into the impact of TEM on functional outcome and quality of life. Patients and methods 19 20 21 U P Results 2 2 1 2 Table 1 Patient and tumour characteristics Characteristics Number N 22/25 Median age in years (range) 67 (40–84) Median distance from dentate line in centimetres (range) 7 (0–15) Median tumour size in square centimetres (range) 20 (4–53) Median capture of circumference of rectal wall in per cent (range) 40 (5–80) Table 2 Procedure-related characteristics Characteristics Number Median duration of operation in minutes (range) 55 (10–140) Complications 4/47 (8.5%) Urinary retention 2 Urinary tract infection 1 Blood transfusion 1 Reoperations None Length of hospital stay in days (range) 4 (3–9) p < 1 p p 3 4 p p p p p p 5 Fig. 1 FISI TEM  Table 3 Mean FISI scores; numbers in parentheses are standard deviations FISI score Pre-operative Post-operative Statistical significance Overall 10 (2) 6 (2) p N 9 (4) 7 (3) p N 12 (3) 4 (2) p N 16 (5) 5 (2) p N 6 (2) 7 (3) p 2 N 12 (4) 6 (3) p 2 N 8 (3) 6 (3) p Lower values indicate better anorectal functioning Table 4 Mean EuroQoL EQ-5D scores; numbers in parentheses are standard deviations   Control group Pre-operative Post-operative Statistical significance EQ-VAS 82 (7) 77 (14) 82 (11) p Index score 86 (6) 84 (11) 89 (9) p EQ-VAS represents the patients’ perspective on quality of life; index score represents the societal value on quality of life. Higher scores indicate higher quality of life. Both scores are compared with a healthy sex- and age-matched control group. Table 5 Mean FIQL scores; numbers in parentheses are standard deviations FIQLS Pre-operative Post-operative Statistical significance Lifestyle 3.7 (0.3) 3.9 (0.3) p Coping 3.6 (0.5) 3.8 (0.4) p Depression 3.7 (0.3) 3.9 (0.4) p Embarrassment 3.1 (0.3) 3.7 (0.4) p Higher scores indicate higher quality of life. Discussion 22 23 24 25 26 17 2 2 16 27 In conclusion, how are these results to be interpreted? This study supports the hypothesis that rectal tumours give rise to incontinence-like symptoms, especially in low-lying rectal tumours. After the tumour is excised using the TEM technique, faecal continence improves. TEM itself does not improve continence but also does not deteriorate faecal continence. Mean quality of life from the patients’ perspective following TEM is improved. Based on, as we know, the only two studies addressing anorectal functioning and quality of life after TEM in one study, it can be concluded that TEM does not impair faecal continence. Also, quality of life is not negatively influenced by the TEM procedure itself, and therefore TEM is the procedure of choice in all rectal adenomas.