A SURGICAL team from Bradford Teaching Hospitals NHS Foundation Trust has played a key role in a pioneering trial which could help improve quality of life for patients with rectal cancer. 

Surgery can often cure early-stage rectal cancer, but in the standard operation, the surgeon will remove the whole rectum, significantly impacting a patient’s quality of life, and often leaving patients with a permanent stoma or colostomy. 

Consultant colo-rectal surgeons Mark Steward and Jon Robinson have favoured a less-invasive approach for patients with early rectal cancer.

They have been treating some of the Trust’s patients in this way since 2006, using a technique called TEMS (trans-anal endoscopic microsurgery). 

TEMS, by contrast to major surgery, is carried out using a specially designed microscope and instruments, allowing it to be performed through the anus inside the rectum.

This does not require any incisions on the outside of the anus or abdomen, preventing patients requiring lifelong stomas. 

Through their development and expertise in TEMS surgery, Mr Steward and Mr Robinson along with their clinical team at Bradford Royal Infirmary have been major contributors to the TREC (Trans-anal Microscopic Surgery for Early Rectal Cancer) study.

The TREC trial assessed whether radiotherapy followed by surgery to remove the part of the rectum affected by cancer using TEMS worked better than surgery to remove the whole rectum.

The study’s results – recently highlighted in The Lancet – are encouraging as for the first time they demonstrated evidence of significant improvement in quality of life among the organ preservation group and fewer side effects.

Mr Steward, who said the Bradford Teaching Hospitals team had continued to treat patients with rectal and colon cancer throughout the pandemic, said that around a quarter of the 11,500 rectal cancers diagnosed in the UK each year could benefit from the new approach.

He said: “The combination of radiotherapy and organ preserving surgery has benefited many with breast, and head and neck cancers, for example, but until very recently management of rectal cancer had lagged behind, but we now have patients who have a better quality-of-life because of the treatment they received at Bradford."

He added: "And with the increase of bowel screening programmes nationwide which will pick up more cases of early-stage rectal cancer, it makes sense to explore more acceptable treatments nationally.”

Further testing and analysis is now needed to see whether the TEMS approach should be adopted throughout the country.