Transanal endoscopic microsurgery in rectal cancer

Leiden Repository

Transanal endoscopic microsurgery in rectal cancer

Type: Doctoral Thesis
Title: Transanal endoscopic microsurgery in rectal cancer
Author: Doornebosch, Pascal Gabriël
Publisher: Faculty of Medicine / Leiden University Medical Center (LUMC), Leiden University
Issue Date: 2010-06-10
Keywords: Local excision
Outcome
Rectal cancer
Transanal endoscopic microsurgery
Tumor selection
Abstract: In rectal cancer total mesorectal excision (TME) is the gold standard. However, driven by the aim to avoid major morbidity and stoma formation, local excision (LE), preferrably with transanal endoscopic microsurgery (TEM), is considered a curative alternative in selected rectal cancer patients. In this thesis the role of TEM in T1 rectal cancer is studied. It was shown that compared to TME, TEM achieves comparable survival rates, however local recurrence rates are as high as 24%, despite a microscopic negative excision margin of at least 2 mm. These recurrences can be managed with radical salvage surgery, but survival in this subgroup of patients is limited, mainly due to distant metastases. Analysis on histopathological evaluation in those recurrent tumors could identify larger tumors at risk for a local recurrence. Accepted high-risk criteria could not be confirmed in our study. Another item in TEM is anorectal functioning postoperative. It was shown that TEM has no detrimental effect on anorectal functioning, as measured with validated questionnaires, and compared to TME leads to less defaction disorders. In the future, special focus of interest should be on identifying rectal cancer in presumed adenomas and on rectal sparing surgery for rectal cancer patients following neoadjuvant chemoradiotherapy.
Description: Promotor: R.A.E.M. Tollenaar, Co-promotor: E.J.R. de Graaf
With summary in Dutch
Faculty: LUMC
Citation: Doornebosch, P.G., 2010, Doctoral thesis, Leiden University
ISBN: 9789085599951
Handle: http://hdl.handle.net/1887/15683
 

Files in this item

Description Size View
application/pdf Full text 1.097Mb View/Open
text/html Ch. 5 and 7 links to published articles 6.923Kb View/Open
application/pdf Cover 60.15Kb View/Open
application/pdf Title page_Contents 99.78Kb View/Open
application/pdf Chapter 1 126.6Kb View/Open Full text at publisher site
application/pdf Chapter 2 69.53Kb View/Open
application/pdf Chapter 3 120.4Kb View/Open Full text at publisher site
application/pdf Chapter 4 138.5Kb View/Open
application/pdf Chapter 5 105.3Kb View/Open Full text at publisher site
application/pdf Chapter 6 111.8Kb View/Open Full text at publisher site
application/pdf Chapter 7 98.68Kb View/Open Full text at publisher site
application/pdf Chapter 8 346.0Kb View/Open Full text at publisher site
application/pdf Chapter 9 147.5Kb View/Open
application/pdf Chapter 10 Summary 89.21Kb View/Open
application/pdf Chapter 11 Summary in Dutch 85.30Kb View/Open
application/pdf List of publications_Currivulum vitae_Afterword 73.38Kb View/Open

This item appears in the following Collection(s)