Amsterdam UMC – Cancer Center Amsterdam is leading several large studies to make treatment for rectal cancer less invasive and tailored to the patient. Two recent international randomized trials, co‑led by Prof. Jurriaan B. Tuynman from CCA, focus on organ preservation and safer surgery, and were published in The Lancet Gastroenterology & Hepatology.
TESAR Trial: Preserving the rectum without compromising cancer outcomes
The TESAR trial studied patients with very early rectal cancer who first had local removal of the tumour. Normally, high‑risk tumours are followed by a major operation: completion total mesorectal excision (cTME). This surgery is effective, but often leads to complications, a stoma and long‑term problems with bowel, bladder and sexual function.
In the TESAR trial, 197 patients in 25 hospitals in the Netherlands and France were randomised to either cTME or adjuvant chemoradiotherapy (targeted radiotherapy of the mesorectum with oral chemotherapy). After three years, local regrowth in the pelvis was slightly higher after chemoradiotherapy (about 5% vs 1%), but almost all could be successfully treated. Serious complications were much less frequent (about 4% vs 26%), stoma rates were far lower (3% vs 45%), and quality of life was similar or better with chemoradiotherapy. This supports chemoradiotherapy as an organ‑preserving alternative to cTME for selected early cancers.
Read the full publication in The Lancet Gastroenterology & Hepatology here.
COLOR III trial demonstrates comparable outcomes for TaTME and LapTME
The COLOR III trial compared two surgical techniques for mid and low rectal cancer: standard laparoscopic TME (LapTME) and transanal TME (TaTME), in 28 hospitals worldwide. Among 1061 patients, short‑term outcomes were similar: operation time, serious complications (around 10%), anastomotic leak (8–10%) and specimen quality were all comparable. A key difference was conversion: with TaTME, conversion was rare (1%), while 17% of LapTME operations had to be converted, often due to a narrow pelvis, low tumour or high BMI. This shows that TaTME is a safe option in experienced hands; enables sphincter saving surgery and reduces technically difficult conversions.
Read the full publication in The Lancet Gastroenterology & Hepatology here.
Together, these trials support a shift towards organ‑preserving and patient‑centred treatment of rectal cancer, with careful selection and high surgical expertise.