Long-term outcome of rectal cancer treatment

Abstract

The current thesis describes the long-term results of rectal cancer treatment, specifically focusing on the etiology of functional morbidity. In a large prospective randomised trial long-term anorectal and urogenital dysfunction after rectal cancer treatment were evaluated. Poor functional outcome appears to occur commonly : about one third of patients reported urinary dysfunction, half of patients suffered from faecal incontinence and more than half of patients experienced deterioration of sexual functioning. Despite an additional effect of radiotherapy, it is concluded that pelvic organ dysfunction is mainly caused by surgical (nerve) damage. A combined anatomic and clinical study shows that the levator ani nerve, which has been neglected so far, might be involved. Furthermore, from a systematic review comparing central ligation techniques, it is concluded that neither the high tie nor the low tie strategy is evidence based and that low tie is anatomically less invasive with respect to circulation and autonomous innervation of the proximal limb of anastomosis. With respect to leukocyte depletion of red blood cell transfusion in patients with gastrointestinal cancer, a combined analysis of two randomised controlled trials shows no better long-term survival and lower cancer recurrence compared to simple buffy-coat removal.