European trials with total mesorectal excision

The outcome after surgery for rectal cancer differs markedly between patien t series regarding local recurrence rates and survival. A high incidence of local recurrence is associated with conventional, nonstandardized procedur es. To improve results of surgery, various additional treatments, such as r adiotherapy, chemotherapy, and immunotherapy, have been tested. The Swedish Rectal Cancer Trial (SRCT) was the first trial to show that better local c ontrol achieved with preoperative radiotherapy resulted in improved surviva l. In recent years local control and survival have been further improved by the introduction of standardized total mesorectal excision (TME) surgery. A major problem of published studies on adjuvant therapy is that surgery wa s not standardized in these studies. Furthermore, quality control of the su rgical technique by standardized pathological examination of the specimen i s absent in most studies. In Europe, TME has become the preferred standard of operative management for rectal cancer. Adjuvant therapy studies should now be reexamined based on a platform of standardized, optimal surgery and pathology. We studied the European trials in which TME surgery is intention ally performed. Most of these trials are still in progress, with follow-up too short for definitive results, apart from interim analyses. However, the Dutch TME trial has already shown that performing a large, multicenter tri al with quality control of both surgery and pathology is feasible. (C) 2000 Wiley-Liss, Inc.