Less blood loss
Precise robotic dissection reduces intraoperative bleeding and the need for transfusions.
Reviewed by Dra. Patricia Tejedor Togores · Updated: June 3, 2026
Specialty
Colorectal Tumors
At Quenet-Torrent Institute, we treat colon and rectal cancer with precision oncological surgery, minimally invasive techniques, and a multidisciplinary approach that maximizes cure options.
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Clinical summary
The treatment of colorectal cancer has undergone a radical transformation in recent years. Quenet-Torrent Institute offers two pioneering strategies that define the global vanguard: the Watch & Wait protocol (active surveillance without surgery) for patients with complete clinical response after neoadjuvant treatment, and Da Vinci robotic surgery of the latest generation for cases requiring surgical resection. Both approaches are developed in direct collaboration with Prof. Julio Garcia-Aguilar, Chief of Colorectal Surgery at Memorial Sloan Kettering Cancer Center (New York) and principal investigator of the OPRA trial, and implemented at the institute by Dr. Patricia Tejedor, colorectal surgeon with a dual fellowship in robotic surgery.
What are colorectal tumors?
Colorectal tumors encompass malignant neoplasms originating in the colon or rectum. Although grouped under the same term in practice, colon cancer and rectal cancer present distinct anatomical differences, staging systems, and therapeutic strategies. The most common histological type is adenocarcinoma, accounting for more than 90% of cases.
In rectal cancer, the location in the narrow pelvis, the proximity to the sphincter apparatus, and the possibility of irradiating before surgery open a unique therapeutic window: some patients who achieve a complete clinical response after total neoadjuvant therapy (TNT) may avoid surgery with the Watch & Wait protocol, preserving the rectum and bowel function. This strategy, validated by the OPRA trial and by more than two decades of experience from Prof. Garcia-Aguilar, is today a consolidated clinical option for correctly selected patients.
The first treatment determines the prognosis
In colorectal oncology, the initial therapeutic decision has a determining impact on long-term outcomes. A well-planned surgery, correct preoperative staging, and the choice between immediate surgery or neoadjuvant treatment can make the difference between preserving the rectum or requiring a permanent stoma, and between local recurrence and lasting cure.
At Quenet-Torrent Institute, every case is assessed in a multidisciplinary committee including a medical oncologist, radiation oncologist, expert rectal MRI radiologist, and colorectal surgeon before any strategy is proposed. This approach ensures that the patient receives the most appropriate treatment from the outset, without rushed decisions.
Main risk factors
Understanding the risk factors allows for the design of personalised screening programmes and anticipates diagnosis at treatable stages:
- Age over 50: incidence increases progressively from this age.
- Family history of colorectal cancer or adenomatous polyps: Lynch syndrome, familial adenomatous polyposis.
- Inflammatory bowel disease (IBD): long-standing ulcerative colitis and Crohn's disease.
- Diet: high consumption of processed red meats and low fibre intake.
- Sedentary lifestyle and obesity: modifiable risk factors with demonstrated impact.
- Personal history: previous adenomatous polyps or already-treated colorectal cancer.
Warning symptoms
If any of the following symptoms are present, especially if they persist for more than two or three weeks, it is essential to consult a specialist:
- Persistent changes in bowel habits (constipation or diarrhoea without apparent cause).
- Blood in the stool or rectal bleeding.
- Iron-deficiency anaemia without identified cause.
- Abdominal pain or sensation of pelvic pressure.
- Involuntary weight loss.
- Intense and unexplained fatigue.
- Sensation of incomplete evacuation (rectal tenesmus).
Diagnosis
Precise tumour staging is decisive for selecting the correct strategy. At Quenet-Torrent Institute, the highest-resolution diagnostic protocols available are used, with particular attention to assessment of the mesorectal fascia, the distance to the circumferential resection margin, and tumour response after neoadjuvant treatment. Standard tests include:
- High-resolution rectal MRI: key test for staging rectal cancer and evaluating response to neoadjuvant therapy.
- Thoracoabdominopelvic CT scan (CT TAP): assessment of local and distant spread.
- CEA tumour marker (carcinoembryonic antigen): baseline value and follow-up.
- PET-CT: in selected cases with suspected dissemination or for staging of metastases.
Watch & Wait: preserving the rectum without surgery
The Watch & Wait strategy (also called non-operative management, or NOM) consists of replacing surgical resection with an intensive surveillance protocol in those rectal cancer patients who achieve a complete clinical response after total neoadjuvant therapy. Instead of removing the rectum, the tumour is closely monitored through high-definition endoscopy, rectal MRI, and periodic clinical examination.
This approach was developed and validated by the group of Dr. Angelita Habr-Gama in São Paulo and subsequently led at a global level by Prof. Julio Garcia-Aguilar through the OPRA trial, the largest randomised study on organ preservation in rectal cancer. The results of the OPRA trial, published in the Journal of Clinical Oncology, demonstrate that the Watch & Wait strategy allows preservation of the rectum and bowel function in a relevant proportion of patients without compromising oncological survival.
The regrowth rate (local recurrence of the tumour) is around 25-30% within the first two years, but in the vast majority of these cases rescue surgery remains possible with curative intent. This is why rigorous follow-up is not optional: it is an integral part of the treatment.
The OPRA trial, led by Prof. Garcia-Aguilar
The OPRA trial (Organ Preservation in Rectal Adenocarcinoma) is the largest randomised clinical study conducted to date on the Watch & Wait strategy in locally advanced rectal cancer. Led by Prof. Julio Garcia-Aguilar from Memorial Sloan Kettering Cancer Center and with the participation of multiple international centres, the trial compared two total neoadjuvant therapy sequences (chemoradiotherapy followed by consolidation chemotherapy versus the reverse order) and evaluated the long-term organ preservation rate. Its results have redefined the standard of treatment for locally advanced rectal cancer worldwide.
"We have been studying the Watch & Wait approach since the early 2000s and have greatly refined who can benefit from it. I have patients who come back to see me 10 years or more after we preserved their rectum without the need for surgery." Prof. Julio Garcia-Aguilar
What does complete clinical response mean?
Complete clinical response (cCR) is defined as the absence of residual active tumour after total neoadjuvant therapy. Assessment requires the integration of several tests performed in a coordinated manner:
- Digital rectal examination: absence of a palpable mass or induration.
- High-definition endoscopy with NBI (Narrow Band Imaging): whitened mucosa, telangiectasias, no ulceration or mass.
- High-resolution rectal MRI: transmural fibrosis without residual tumour signal (mrTRG 1-2).
- Thoracoabdominopelvic CT scan: absence of pathological lymph nodes or distant metastases.
- Tumour markers (CEA): normalisation or significant decrease.
What does the follow-up involve?
The Watch & Wait follow-up protocol is more demanding than standard postoperative care. The objective is to detect any local regrowth early and act with rescue surgery before the tumour progresses. Reviews combine clinical examination, high-definition endoscopy, and rectal MRI on a periodic basis. The frequency is adapted to each patient's individual evolution:
| Period | Usual follow-up |
|---|---|
| First 2 years | Reviews every 3 months |
| Years 3-5 | Reviews every 6 months |
| After 5 years | Individualised follow-up according to risk, evolution, and medical judgement |
Who can benefit from Watch & Wait?
Not all patients with rectal cancer are candidates for Watch & Wait. Correct selection is fundamental to guaranteeing oncological safety. The best candidates are patients with locally advanced rectal cancer who have received total neoadjuvant therapy (chemoradiotherapy plus consolidation chemotherapy with capecitabine and oxaliplatin) and who demonstrate a complete clinical response documented by the aforementioned tests. Other factors include tumour location (mid-low rectum, where surgery would carry a greater risk of stoma), the absence of mutations limiting response to neoadjuvant therapy, and the patient's commitment to rigorous long-term follow-up.
Da Vinci® robotic surgery in colorectal cancer
When rectal cancer requires surgical resection, robotic surgery with the Da Vinci system represents the highest-precision approach available. The pelvis is a narrow anatomical space, with critical nerve structures for sexual, urinary, and bowel function that must be preserved during resection. The Da Vinci robot, with its magnified three-dimensional vision and 540-degree articulation, allows manoeuvring in that space with a precision that open or conventional laparoscopic surgery cannot match.
Quenet-Torrent Institute uses the fifth-generation Da Vinci, the most advanced system currently available, with higher image resolution, thinner instrumentation, and better integration of intraoperative fluorescence (ICG). This system allows intestinal anastomoses to be performed with real-time verification of vascular perfusion, reducing the risk of anastomotic leak.
Surgical experience in this technique is a determining factor in outcomes. Prof. Julio Garcia-Aguilar has been performing robotic colorectal surgery for more than 25 years, having introduced techniques that are today a global reference in nerve preservation and resections in complex pelvises. Dr. Patricia Tejedor completed two specific fellowships in colorectal robotic surgery in 2019 and 2021, consolidating her training at the highest-volume centres in Europe in this specialty.
Advantages of robotic surgery in colorectal cancer
Da Vinci robotic surgery offers documented clinical advantages over open and conventional laparoscopic surgery in the treatment of colorectal cancer:
Less postoperative pain
Minimal incisions and reduced tissue manipulation result in less pain and reduced analgesic consumption.
Faster recovery
Patients resume their usual activity sooner, with shorter hospital stays.
Lower conversion rate to open surgery
The robot's articulation allows resection to be completed in difficult pelvises without the need to extend incisions.
Precise mesorectal dissection
Total mesorectal excision (TME) with negative margins is technically superior with the robot in narrow pelvises.
Autonomic nerve preservation
The magnification and 3D vision of the Da Vinci facilitates identifying and preserving the hypogastric nerves and pelvic plexuses, reducing postoperative sexual and urinary dysfunction.
Functional preservation
The robotic approach maximises the possibilities of preserving the sphincter apparatus and avoiding a permanent stoma.
Da Vinci 5th generation
Precision that changes both the oncological and functional outcome
The Da Vinci 5 robotic system enhances the surgical field with high-definition 3D vision, articulated instruments with 7 degrees of freedom, and physiological tremor filtering. In narrow pelvises, low tumours, and salvage surgeries, this combination translates into cleaner and safer dissection.
What matters is not the robot but the team that operates it: Prof. Garcia-Aguilar has over 25 years of minimally invasive colorectal surgery experience and Dr. Tejedor brings two dedicated fellowships in robotic colorectal surgery (2019 and 2021).
When to request a second opinion?
A second opinion is not a sign of distrust towards the treating physician: it is an internationally recognised clinical tool to ensure the patient receives the most appropriate treatment. It is especially recommended in the following situations:
- Recent diagnosis of locally advanced rectal cancer and doubt about the therapeutic plan.
- Proposal for a permanent colostomy without having explored sphincter preservation or Watch & Wait.
- Doubts about the resectability of the tumour or of hepatic or pulmonary metastases.
- Local recurrence or progression after previous treatment.
- Cases ruled out for surgery due to high technical complexity.
- Peritoneal carcinomatosis of colorectal origin with an exclusively palliative proposal.
At Quenet-Torrent Institute, a comprehensive surgical reassessment is carried out, reviewing all clinical documentation, imaging tests, and pathology to issue an independent report with the most appropriate strategy for each case.
Treatments according to tumour type
The therapeutic strategy is adapted to tumour type and stage, anatomical location, and response to neoadjuvant treatment:
| Tumour type | Treatment |
|---|---|
| Colon cancer | Segmental colectomies, preferably robotic |
| Rectal cancer, Watch & Wait | Intensive surveillance without resection if complete response to TNT |
| Rectal cancer, robotic surgery | Low/ultralow anterior resections with Da Vinci, sphincter preservation |
| Locally advanced tumours | Abdominoperineal resection with robotic surgery in complex pelvises |
| Metastatic cases | Surgery after response + resection of hepatic/pulmonary metastases + selected CRS+HIPEC |
Metastatic cases: options beyond initial surgery
Metastatic colorectal cancer is not always a situation without curative options. In centres with experience in complex oncological surgery, a significant proportion of patients with metastases may qualify for treatment with curative intent or long-term control. Options available at Quenet-Torrent Institute include:
- Liver metastases: synchronous or staged hepatic resection in patients with resectable hepatic disease. More information on liver metastases.
- Colorectal peritoneal carcinomatosis: peritoneal cytoreduction plus HIPEC in selected cases with low tumour burden. More information on colorectal carcinomatosis.
- HIPEC (hyperthermic intraperitoneal chemotherapy): combined with cytoreductive surgery for peritoneal disease. More information on HIPEC.
- Resectable pulmonary metastases: joint assessment with thoracic surgery for resection in cases with limited disease.
Dr. François Quenet, with a career spanning more than two decades in high-complexity oncological surgery, leads the most challenging cases at the institute. View Dr. François Quenet's profile.
Our technology
Technology at the service of the patient
Every clinical decision at Quenet-Torrent Institute is supported by the highest-precision diagnostic and surgical technology:
| Technology | Application |
|---|---|
| Total neoadjuvant therapy (TNT) | Maximise organ preservation |
| High-resolution rectal MRI | Watch & Wait candidate selection |
| Endoscopy with NBI | Tumour response assessment |
| 3D surgical planning | Approach precision |
| Da Vinci® robotic surgery | Precise resections in narrow pelvises |
| Intraoperative fluorescence (ICG) | Safe anastomoses |
| ERAS protocols | Accelerated postoperative recovery |
Specialised medical team
The specialists behind each case
Prof. Julio Garcia-Aguilar
Chief of Colorectal Surgery at Memorial Sloan Kettering Cancer Center (New York) and Holder of the Benno C. Schmidt Chair in Surgical Oncology. Principal investigator of the OPRA trial and a global reference in organ preservation in rectal cancer. With more than 25 years of experience in robotic colorectal surgery, he is the surgeon who introduced techniques now adopted as international standards. He collaborates with Quenet-Torrent Institute on the Watch & Wait protocol and in team training.
Dr. Patricia Tejedor
Colorectal surgeon
View doctorDoctor in Medicine (Summa Cum Laude, UAM) and Consultant in the Colorectal Surgery Unit at Hospital Gregorio Marañón. Over 100 scientific publications, member of the Editorial Board of the British Journal of Surgery and the Programme Committee of the ESCP. Principal investigator of the ADiFAS, PEARLS, and PROCaRe studies. Dual fellowship in colorectal robotic surgery (2019 and 2021).
Dr. François Quenet
Oncological Surgeon
View doctor"As an oncological surgeon, my experience treating colorectal tumours has taught me that surgery remains the fundamental pillar in curing this disease."
Dr. Carlos Rodriguez
Colorectal Surgeon
View doctor"For me, oncological colorectal surgery is a discipline where anatomy, precision, and decision-making meet science and empathy."
Success stories
View on Google
★★★★★
What patients treated by the team say
(Original reviews in Spanish, authentic patient testimonials)
K
Hace 5 meses
★★★★★
A mi padre en la Salud pública le daban un año de vida máximo. Solo le daban un tratamiento de quimio y ninguna esperanza, decían que era imposible, que no se podía hacer nada por él. Tenía varios tumores dentro del saco peritoneal con metástasis. Un año y medio después está limpio, totalmente curado. En el último PET (prueba de imagen) ha salido limpio. Estamos muy contentos. Gracias al Dr. Torrent y su equipo. GRACIAS.
F
Hace 6 años
★★★★★
Tengo carcinomatosis peritoneal. Enviando mi diagnóstico a todos los centros, prácticamente todos coincidían en una quimio paliativa con poco tiempo de supervivencia ya que tenía un tipo de células muy agresivas. Hasta que llegamos al Dr. Quenet, Dr. Torrent y su equipo. Solo puedo confirmar lo que su currículo anuncia: están muy lejos del resto. Me salvaron la vida, ya que en la operación no se daban las células dañinas que todos diagnosticaban y por las que no me operaban. Esta intervención se ha convertido en la mejor inversión de mi vida.
P
Hace 2 años
★★★★★
Soy una paciente de 63 años. Me detectan un cáncer de la glándula suprarrenal y me dicen que no hay nada que hacer. Busco una segunda opinión y me hablan del equipo Quenet Torrent, especialistas en operaciones complejas. El doctor Torrent, desde el primer momento, me dice que pueden operarme. Me intervienen y me extraen una gran masa tumoral. Estuve una semana en la UCI y un mes en planta. Cada día pasaba mañana y tarde, daba igual sábado que domingo. No hay que arrojar la toalla. Soy feliz por haber encontrado a estos profesionales que me han devuelto la vida. Gracias.
M
Hace un año
★★★★★
Excelentes profesionales, en especial el Dr. Torrent, pendiente en todo momento de la paciente (mi esposa), operada de pseudomixoma peritoneal. Nos ayudaron con todas nuestras necesidades puesto que veníamos de fuera de Barcelona. Gracias Elisabeth. Estamos muy agradecidos al Quenet Torrent Institute, gracias por todo.
L
Hace 4 semanas
★★★★★
Maravilloso equipo quirúrgico, de lo mejor que hay. El Dr. Torrent (experto en carcinomatosis peritoneal) es un cirujano excepcional y mejor persona. Su coordinadora súper amable, rápida y eficiente. El trato humano es estupendo y los resultados también. Esto es de vital importancia para los pacientes con cáncer.
M
Hace 5 años
★★★★★
El Dr. Torrent me ayudó a tomar la mejor decisión en un momento difícil. Pienso que es un gran profesional y una persona que es capaz de acompañar y ponerse en el lugar del otro. Gracias por todo.
Frequently asked questions about colorectal tumors
Answers to the most common questions about Watch & Wait, robotic surgery, and the treatment process.
Can all rectal cancer patients undergo Watch & Wait?
No. Watch & Wait is only appropriate for patients who achieve a complete clinical response after total neoadjuvant therapy. It requires precise staging with high-resolution rectal MRI and high-definition endoscopy, as well as the patient's commitment to intensive long-term follow-up. Incorrect candidate selection compromises oncological safety.
Who decides whether I can avoid surgery?
The decision is made in a multidisciplinary committee, integrating the views of the colorectal surgeon, medical oncologist, radiation oncologist, and radiologist specialised in rectal MRI. At Quenet-Torrent Institute, the Watch & Wait protocol is implemented in close collaboration with Prof. Garcia-Aguilar's methodology (Memorial Sloan Kettering Cancer Center).
What happens if the tumour comes back during Watch & Wait?
Local recurrence (regrowth) occurs in approximately 25-30% of cases within the first two years. In the vast majority, when detected early through intensive follow-up, rescue surgery is possible with curative intent. This is why rigorous follow-up is an inseparable part of the protocol.
Can surgery cure colorectal cancer?
Yes. In localised tumours or with resectable metastases, complete surgical resection is the only route with curative intent. In stages I-II, 5-year survival exceeds 80%. In stage III, with adjuvant chemotherapy, it reaches 60-70%. In selected metastatic cases, surgery combined with other treatments can achieve prolonged survival.
Is it always possible to avoid a stoma?
Not always, but in most rectal cancer cases it is possible to preserve the sphincter apparatus with advanced robotic techniques or with Watch & Wait in complete responders. The need for a permanent stoma depends on tumour location, stage, patient anatomy, and response to treatment. Each case must be assessed individually before assuming it is unavoidable.
What role does HIPEC play in colorectal cancer?
HIPEC (hyperthermic intraperitoneal chemotherapy) combined with cytoreductive surgery is an option for patients with peritoneal carcinomatosis of colorectal origin and low peritoneal tumour burden. It is not applicable to all cases, but in correctly selected patients it can offer lasting oncological control. More information on HIPEC.
How long is recovery after robotic surgery?
With ERAS (enhanced recovery after surgery) protocols, the usual hospital stay after robotic colorectal resection is 3 to 5 days. Full functional recovery to resume moderate activity usually occurs between 3 and 6 weeks, depending on the type of resection and the patient's general condition.
Do you treat patients from outside the city or country?
Yes. Quenet-Torrent Institute regularly treats patients from across Spain and from other countries. The team coordinates the remote reception of clinical documentation to provide an initial assessment before the patient travels, and organises the care process to minimise the number of trips required. For international patients, logistical support throughout the process is also arranged.
Would you like an expert assessment of your case?
The Quenet-Torrent Institute team reviews each case individually, with access to the most advanced protocols in organ preservation and colorectal robotic surgery. If you have questions about your diagnosis, the proposed treatment plan, or the options available, contact us.
Where to treat colorectal tumors?
We operate in two private hospitals of reference in Spain. The same medical team treats you in Madrid and Barcelona, with the same surgical and oncological standards.
Barcelona
Centro Médico Teknon
Internationally recognised private hospital in Barcelona where the team carries out its high-complexity surgical oncology activity.
View hospital
Madrid
Memorial Publio Cordón Hospital
Private hospital in Pozuelo de Alarcón with a multidisciplinary team specialised in digestive surgical oncology and cutting-edge surgical technology.
View hospital
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