Rectal neuroendocrine neoplasms (NEN) are increasingly diagnosed worldwide Compared to colonic NEN's, they are commonly smaller, less aggressive, with a low to intermediate grade of differentiation. A 5-year survival rate as high as 88% has been reported[1,2]. The risk of malignancy is closely related to tumour size, depth of invasion and lymph node involvement [1-3]. The incidence of lymph node metastasis increases with tumour (1-10mm 5.4%, 10-20mm 30%, >21mm 70%). The risk of lymph node metastasis increases with tumour depth (12% if submucosa is involved and 56% when the muscolaris propria is involved) [3-5]. This article is protected by copyright. All rights reserved.