In the Netherlands around 10.000 patients are diagnosed with colorectal carcinoma every year, of who about 2500 have rectal carcinoma (www.oncoline.nl). It is the third most common cancer in men ... Show moreIn the Netherlands around 10.000 patients are diagnosed with colorectal carcinoma every year, of who about 2500 have rectal carcinoma (www.oncoline.nl). It is the third most common cancer in men (after prostate and lung cancer) and the second most common in women (after breast cancer). In the treatment of rectal cancer a multi-disciplinary approach is the best way to achieve optimal outcomes. Imaging, (neo)adjuvant therapy, surgery and pathology will be discussed separately to define their role in the treatment of rectal cancer. The principle investigation method of this thesis is the analysis of the patterns of local recurrence of rectal cancer. By determination of the location of locally recurrent rectal cancer on imaging and relating these to patient, treatment and tumor variables, the mechanism of local relapse genesis is reconstructed. By doing this the effect of neoadjuvant treatment, surgery, intra-operative radiotherapy and adjuvant treatment on local control can be quantified. First patterns of local recurrence are described for rectal cancer in general (Chapters 3-5) and then only for locally advanced rectal cancer (Chapters 6-7). Subsequently, the effect of preoperative evaluation of local recurrent rectal cancer on results of the multimodality treatment of local relapse is analyzed (Chapters 8-9). Show less
This thesis focuses on quality assurance of rectal cancer treatment, in particular of the surgical treatment. Both oncological short-term and long-term outcome parameters are studied, but also... Show moreThis thesis focuses on quality assurance of rectal cancer treatment, in particular of the surgical treatment. Both oncological short-term and long-term outcome parameters are studied, but also other end-points which are important for quality assurance are investigated, such as anastomotic leakage and stoma reversal. The introduction of total mesorectal excision (TME) surgery resulted in an improved survival of patients with rectal cancer. However, survival of the elderly patients and patients treated with an abdominoperineal resection improved less. For frail elderly patients, postoperative mortality is an important competitive risk factor and other treatment schedules might be more appropriate. The abdominoperineal resection itself was associated with a nonradical resection, decreased local control and decreased survival compared to patients treated with a low anterior resection. To improve these results, in selected cases preoperative treatment should consist of chemoradiotherapy and/or a widened resection. Anastomotic leakage is a feared complication after colorectal surgery. After surviving this complication, the overall survival rate in the long-term is still reduced. However, oncological outcome was not significantly affected. The presence of a stoma resulted in a lower symptomatic leakage rate. 20% of stomas was never reversed. Standardised postoperative surveillance resulted in an earlier confirmation of the diagnosis anastomotic leakage. Show less
