???????? ?????? ?????????????????????? ????????????????????: Harm Rutten!

Despite being described as a surgeon who “since the 90’s has worked tirelessly to care for patients with locally advanced and recurrent rectal cancer, becoming an icon in this field in the Netherlands and with a reputation that stretches far beyond the country’s borders,” – Harm Rutten humbly classifies himself as ‘a family man’.

More about that later. In the early days Harm was a breast cancer surgeon who also operated on head and neck cancer. As patient loads continued to increase, he started to specialise in complex colorectal cancer surgery. The more he honed his skills in this area, the more he saw opportunities for improved outcomes and possibilities for more diverse treatment approaches.

“We started to recognise that that total mesorectal excision (TME) surgery could be improved just by improving your surgical skills, some of the patients survived which would not have happened with TME surgery alone. As a proctor I visited several hospitals, and I invited those doctors to bring their difficult patients to my hospital, so we could treat them together.”

Those developments have culminated into the ‘interoperative radiation therapy’ – chemotherapy during surgery, where an electron beam is applied directly on the area at risk. His team has also seen major improvements in outcomes by improving pre-treatment before surgery, the reason why Catharina has become one of the largest cancer treatment centres in Europe.

Harm’s patient-focussed approach is no accident:

“Cancer is all about the patient. Cancer is something which is really threatening your life. Patients get confronted with existential problems, and so every cancer patient is in my opinion an interesting case. Having the opportunity to help these patients, to offer treatments which could save them, is something that is very appealing to me. When I started in surgery general surgeons would do oncologic surgery, proctology, orthopaedic surgery and gastrointestinal surgery. There was a big need for differentiation and specialisation. The Netherlands is one of the countries that has forged ahead with differentiation and specialisation in surgery.”

When treatment became more specialised, the first people to benefit from this treatment was the elderly. Being more fragile and more likely to develop complications, Harm took it upon himself to research this area and noticed that there were high mortality rates in these patients. That was some twenty years ago. Nowadays Harm and his team have managed to improve outcomes in elderly patients, so they do not have a higher mortality rate at this moment than younger counterparts. Other things changed as well: anaesthesia, rehabilitation became better. By recognising frail patients, they improved their condition before any surgery was performed. Harm wants his peers to better understand better the needs of the elderly patient, then in turn how to treat them.

Organ preservation is one of Harm’s goals when it comes to what he hopes to add to his long list of achievements.

“In the upcoming years we will become much better in delivering the right systemic treatment, the right chemotherapy. One of the things we are introducing in our hospital, like in Maastro in Maastricht is the use of endorectal radiotherapy. We have interoperative radiotherapy in open abdominal surgery, you can also introduce very small tubes via the anus and directly irradiate in combination with external radiotherapy.”

In the past, the most challenging part of Harm’s work was finding funding. Having always been an issue, the last few years have seen an influx of funds, now the challenge is spending in a proper way.

?“Since becoming a Professor of Oncological Surgery in 2013, it did help to open doors. This affiliation has helped me to have quite a number of PhD students, it made it possible to attract funding. If you are a professor and you ask for funding, it is different if you are a surgeon in a non-academic hospital asking for funding. I didn’t realise any funding before becoming a professor. We never had any funding and now we don’t know how to spend it.”

Harm’s self-profession for all things family shines through when asked about what brings him joy. With four children all grown up and one grandson who is a vibrant and energetic one-year-old, helping his children with work around their houses and gardens – despite the fact that surgeons aren’t encouraged to do such things with their hands – fills him with great pleasure. Having retired from surgery in July 2021, he now has time to focus on research, which he feels is another way to intensify the collaboration with Maastricht.

“I used to be a ‘spare time’ professor. I am looking forward to being able to sit with my students the whole day long and not just ten minutes here and there.”

We can imagine that his students are just as pleased to have more time with Harm, and this focussed attention on his students will go on to benefit thousands more patients for years to come.