Transanal Endoscopic Microsurgery (TEM) is a commonly used surgical procedure for the treatment of rectal tumors. It primarily achieves en bloc resection through a multi-functional surgical operating system of rectoscopes and has been widely applied in surgeries for benign lesions such as rectal adenomas, early-stage rectal cancer, and various rare rectal diseases. Compared with open transabdominal surgery or laparoscopic surgery, TEM offers higher precision, less trauma and pain, shorter recovery time, and better functional preservation. In recent years, neoadjuvant chemoradiotherapy combined with local resection has provided a new direction for the comprehensive treatment of advanced rectal cancer. However, the effectiveness of neoadjuvant chemoradiotherapy combined with TEM remains controversial. This study analyzes and summarizes the research progress of TEM in the treatment of rectal tumors in recent years, aiming to provide a reference for future clinical treatment.