Multidisciplionary Treatment of Rectal Cancer and Other Pelviv Tumours

Colorectal 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.