Local Recurrence of Premalignant and Early Malignant Rectal Polyps Treated by TEM—A Single-Center Experience

<b>Background:</b> Transanal endoscopic microsurgery (TEM) is a minimally invasive approach for excising rectal polyps, particularly those with high-grade dysplasia (HGD) or early-stage rectal cancer (T1). This study aimed to evaluate the recurrence risk and its associated factors in patients treated with TEM for HGD and T1 rectal tumors. <b>Methods:</b> A retrospective review was conducted on 79 patients who underwent TEM for rectal lesions at Rabin Medical Center-Hasharon Hospital from 2005 to 2019. Data collected included demographics, tumor characteristics, and follow-up outcomes, with specific focus on tumor size, resection margins, mucin production, and distance from anal verge (AV). Separate and unified analyses were performed to assess the recurrence risk factors for both HGD and T1 patients. <b>Results:</b> Sixty-three patients were included in the final analysis. In the unified analysis, larger tumor size was significantly associated with increased recurrence risk (OR = 2.27, <i>p</i> = 0.028), and mucin production was a strong predictor of recurrence in the T1 group and combined analysis (<i>p</i> = 0.0012 and <i>p</i> = 0.014, respectively). Distance from AV demonstrated a borderline association with recurrence (<i>p</i> = 0.053). <b>Conclusions:</b> Larger tumor size and mucin production are significant predictors of recurrence in TEM-treated rectal polyps. Personalized follow-up and postoperative management are essential for patients with these risk factors to reduce the recurrence risk.