Transanal total mesorectal excision in the era of robotic surgery
Mené sur 1 103 patients atteints d'un adénocarcinome rectal (68 % d'hommes ; âge médian : 63 ans), cet essai randomisé international de phase III évalue la non-infériorité, du point de vue du taux de récidive locale à 3 ans, d'une exérèse complète du mésorectum par voie transanale par rapport à une exérèse laparoscopique
Preliminary results from the long-awaited COLOR III trial by Jurriaan Tuynman and colleagues, published in The Lancet Gastroenterology & Hepatology, show that transanal total mesorectal excision (TaTME) was non-inferior to laparoscopic TME (LapTME) with respect to 90-day overall and major morbidity, TME specimen quality, and R0 resection rates. The COLOR III trial was designed to compare TaTME with LapTME at a time when robotic total mesorectal excision (rTME) was in its early adoption phase and LapTME was associated with rates of at least 10% positive circumferential resection margins, up to 25% abdominoperineal resection, and 10–20% conversion to open surgery, particularly for distal rectal tumours in male patients with obesity.2,3 COLOR III was conceived 5 years after the report of the first TaTME case performed for mid-rectal cancer. Early publications evaluating this approach suggested that enhanced visualisation, along with improved manoeuvrability through transanal endoscopic multitasking platforms, could facilitate R0 resections and sphincter preservation. However, early adopters also reported TaTME-specific complications attributed to the learning curve, lack of standardised technique, and suboptimal patient selection.5 COLOR III was specifically designed to address safety, standardisation, and quality concerns through a rigorous trial framework. The quality assurance framework in COLOR III was more stringent than any prior randomised multicentre TME trial. The 2:1 TaTME to LapTME randomisation ensured high TaTME case volume, detailed characterisation of TaTME-specific complications, and robust subgroup analyses. Trial quality assurance required previous dedicated TaTME training and embedded a video-based LapTME and TaTME competency assessment tool into trial site selection and ongoing performance monitoring. Centralised review of initial and post-treatment pelvic MRI to confirm eligibility also served to reduce misclassification and selection bias.
The Lancet Gastroenterology & Hepatology , commentaire en libre accès, 2026