Management of early neoplasms and surgical complications of the rectum

Colorectal cancer (CRC) is one of the most common cancers in the world and is expected to rise from 1.4 million annually diagnosed patients worldwide in 2012 to 2.4 million patients by 2035. In the Netherlands, currently 13,000 new patients are diagnosed with CRC each year, of which approximately one third have rectal cancer. The prognosis of patients with rectal cancer has improved significantly during the last two decades in the Netherlands. The cornerstone of locoregional treatment is still surgery, and improved quality of resection as well as locally advanced rectal cancer by specialised surgical teams contributed substantially to these improvements. Rectal cancer surgery is complex and requires specific expertise. But despite specialisation and centralisation, there is still a relatively high risk of postoperative complications. In contrast to literature on treatment of rectal cancer, prevention and treatment of short and long-term surgical complications has less extensively been explored. At the time prognosis improves, quality of life and management of treatment related morbidity becomes more and more important. Treatment of rectal cancer requires a multidisciplinary evidenced based approach, in which the treatment related morbidity has to be weighed against the expected health benefit. This thesis starts with a chapter on endoscopic treatment of the precursor lesions of rectal cancer. In the subsequent chapters, several complications after rectal surgery are discussed, focussing on predictive factors, prevention, and evaluation of treatment modalities.