- Author
-
R.D. Blok
- Title
- Next steps in surgical colorectal cancer care
- Subtitle
- Optimising efficacy and reducing morbidity
- Supervisors
-
J.P. Medema
P.J. Tanis - Co-supervisors
-
R. Hompes
- Award date
- 11 February 2021
- Number of pages
- 287
- ISBN
- 9789464163254
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
This thesis aims to discuss several surgical strategies in patients with colorectal cancer, from the perspective of optimising efficacy and reducing morbidity. In Part I, we focussed on the utility of an omentoplasty for improving the postoperative course of rectal cancer patients that underwent excision of the anorectum (APR), and learned that omentoplasty does not promote wound healing nor reduce risk of secondary infection. Actually, omentoplasty appeared associated with an added risk of complications such as perineal hernia, or chronic sinus if not properly performed. In Part II, we addressed other perineal wound closure strategies following APR. Although use of a prophylactic biological mesh lowered the incidence of perineal hernia, there was no impact on wound healing problems. Thus, a new strategy was proposed to enhance primary wound healing after APR using a small gluteal turnover flap. Final conclusion on the efficacy of this method cannot yet be drawn, but from this thesis one may conclude that the technique appears safe and feasible for routine closure after APR. Lastly, while the first two parts of this thesis have focussed on the surgical aspect of the treatment, Part III depicts the feasibility of utilising surgical resection to guide systemic therapy in colorectal cancer care. From the research of this thesis we may conclude that it appears feasible to establish patient-specific drug profiles using tumour organoids derived from surgical resection specimens, but several technical limitations need to be overcome before clinical implementation is warranted.
- Persistent Identifier
- https://hdl.handle.net/11245.1/6565700b-f73d-4c63-bf20-03bbae0d86b3
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline of the thesis
Chapter 2: Snapshot study on the value of omentoplasty in abdominoperineal resection with primary perineal closure for rectal cancer
Chapter 3: Propensity score adjusted comparison of pelviperineal morbidity with and without omentoplasty following abdominoperineal resection for primary rectal cancer
Chapter 4: A systematic review and meta-analysis on omentoplasty for the management of abdominoperineal defects in patients treated for cancer
Chapter 5: CT assessment of the quality of omentoplasty and its implications for perineal wound healing
Chapter 6: Near-infrared fluorescence angiography for intra-operative assessment of pedicled omentoplasty for filling of a pelvic cavity: A pilot study
Chapter 7: Cumulative 5-year results of a randomized controlled trial comparing biological mesh with primary perineal wound closure after extralevator abdominoperineal resection (BIOPEX-study)
Chapter 8: Further insights into the treatment of perineal hernia based on the experience of a single tertiary centre
Chapter 9: Gluteal transposition flap without donor site scar for closing a perineal defect after abdominoperineal resection
Chapter 10: Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer
Chapter 11: Perineal wound closure using gluteal turnover flap or primary closure after abdominoperineal resection for rectal cancer: Study protocol of a randomised controlled multicentre trial (BIOPEX-2 study)
Chapter 12: A patient-derived colorectal cancer organoids model to study individual responses to chemotherapy and guide personalised systemic treatment
Chapter 13: Summary and conclusions
Chapter 14: General discussion and future perspectives
Nederlandse samenvatting en conclusie; List of publications; Ph.D. portfolio; Dankwoord/Acknowledgements; About the author
- Supplementary materials
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