Multidisciplionary Treatment of Rectal Cancer and Other Pelviv Tumours
2009
textabstractColorectal cancer is a major problem in the western world and has a rising incidence.
[1,2] Approximately one third of these tumours originate in the rectum. Although colon
and rectal cancer share similar features there is a distinct difference in clinical behaviour
and therapeutical approach.[3] The treatment of primary rectal cancer has evolved into a
multidisciplinary treatment with standardised imaging techniques, surgical procedures,
pathological assessment, and (chemo)radiation therapeutical options.[1, 4-6] The
introduction of total mesorectal excision (TME) has lead to a significant decreased local
recurrence rate[7] in combination with preoperative short-term radiotherapy (5x5Gy).[8, 9]
Based on the beneficial results reported in the Dutch TME trial[1] the treatment protocol in
the Netherlands of patients with a tumour in the lower two-third of the rectum was changed
in 2001.[10] Nowadays all patients are considered to be discussed in a multidisciplinary team
and a short course of radiotherapy will be given prior to TME surgery. It is unclear if results
in community hospitals are similar to the results presented in these multicenter trials. In
chapter 2 we report the results of rectal cancer surgery in a low volume community hospital
in the region of the Comprehensive Cancer Centre Rotterdam. The aim of the study was to
identify the compliance to the new standardised treatment protocol i.e. the introduction
of preoperative radiotherapy. Furthermore, the results of rectal cancer treatment in the
centre were analysed and compared with reference values based on selected patients from
randomised trials in the recent literature.
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