Quality assurance in surgical oncology

Abstract

Quality of surgical procedures in the treatment of cancer patients is of utmost importance. This thesis focuses on two large prospective randomised trials on gastric and rectal cancer. Important feature in both trials was the standardisation and quality control of surgery, enabling the reliable assessment of the rol of adjunctive therapies. The trial on gastric cancer showed no benefitit of extensive lymph node dissection in gastric cancer. However, if postoperative morbidity is reduced, extended surgery may be of benefit. Various ways of reducing the likelihood of postoperative complications are considered. The trial on rectal cancer patients showed that short term preoperative radiotherapy is capable of reducing the risk of local recurrence, which however does not lead to improvement of survival. Moreover, there are important side effects of radiotherapy, the most important one being the increased incidence of fecal incontinence in irradiated patients.