Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
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One of the major problems in the treatment of rectal cancer has been the inability to achieve local control. Traditional surgery, now outmoded, involves blunt digital dissection and was associated with a high incidence of local recurrence. In an attempt to improve local control and survival, many adjuvant treatment modalities have been investigated. ⋯ This has resulted in such low recurrence rates and improved survival that the question had to be answered whether pre-operative short-term radiotherapy is still beneficial in TME treated patients. The question was answered in the TME trial set up by the Dutch ColoRectal Cancer Group that randomised between standardized and quality-controlled TME surgery alone and TME surgery preceded by short-term pre-operative radiotherapy. This paper reviews the developments in the treatment of resectable rectal cancer, highlights the results from the Dutch TME trial, and considers future directions in improving outcome.