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
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... Show moreThe 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. Show less
