Surgery is considered the golden standard to treat the primary tumour and regional spread of many different cancer types. In addition to the pathological evaluation of surgical margins, the... Show moreSurgery is considered the golden standard to treat the primary tumour and regional spread of many different cancer types. In addition to the pathological evaluation of surgical margins, the evaluation of lymph nodes is needed to stage the metastatic dissemination of the disease [1,2]. Both these aspects are critical in accomplishing radical excision and are, as such, providing true prognosis. However, the quest for complete cure should be in balance with the desire for minimally invasive surgery [3–5]. Hereby it can be assumed that surgical side effects may negatively influence the patient’s quality of life. Advanced image guided surgery technologies can be used to improve the surgical resection and to minimize the invasive nature of the procedure [6]. In this thesis both these technologies are discussed. Hereby we focussed on the locoregional assessment of the lymphatic tumour spread via sentinel lymph node procedures [7–11]. In addition technologies that support nerve-sparing surgery have been pursued. To realize these ambitious goals, a combination of imaging modalities has been used, ranging from fluorescence to nuclear imaging and hybrid combinations of the same. Show less
The thesis is on tailoring therapy in endometrial and cervical cancer. The standard treatment for endometrial cancer is a hysterectomy with bilateral salpingo-oophorectomy. This means definitive... Show moreThe thesis is on tailoring therapy in endometrial and cervical cancer. The standard treatment for endometrial cancer is a hysterectomy with bilateral salpingo-oophorectomy. This means definitive sterilisation for women in their fertile age. Treatment with progesterones is widely used, but the treatment needs evaluation and improvement since recurrences are frequent after response. This thesis gives an overview of the literature on this topic in chapter 2. Chapter 3 describes a study on molecular and histopathological changes is women on progesterone treatment to predict responders to therapy. Standard treatment of cervical cancer is a radical hysterectomy. Conventional radical hysterectomy damages nerves in het pelvic area and this results in therapy induced morbidity: urinary, bowel and sexual dysfunction. Chapter 4 is a systematic review and meta-analysis on nerve sparing radical hysterectomy versus non-nerve sparing radical hysterectomy, evaluating survival outcomes and quality of life. In chapter 5 the long term oncological outcomes of the conventional radical hysterectomy, the former Leiden nerve sparing hysterectomy and the nerve sparing Swift procedure, all performed at the LUMC are compared. In chapter 6 fertility and nerve sparing treatment are combined and the results of the abdominal trachelectomy performed at the LUMC is analysed. Show less