Colorectal cancer is common with a high mortality rate despite significant advances in its management. While outcomes for rectal cancer have improved over recent years, outcomes for low rectal cancer. and colon cancer have not improved to the same degree. Studies were designed to investigate the optimal operations for both low rectal cancer and colon cancer using tissue morphometry and assessment of the surgical planes. Additionally, the utility of tumour cell density as a prognostic marker and a method of assessing the response to pre-operative treatment was investigated. Extralevator 'abdominoperineal excision for low rectal cancer was shown to be associated with better pathological outcomes and planes of surgery when compared to standard abdominoperineal excision. Careful mesocolic plane surgery for colon cancer was associated with better survival when compared to disrupted specimens. Complete mesocolic excision with central vascular ligation and Japanese D3 resection resulted in an oncologically superior specimen when compared to standard surgery. They could both be performed laparoscopically and were easily adopted by a group of highly motivated surgeons. Tumours with a low tumour cell density appeared to have an independently worse prognosis, and the same technique generated a useful measure of response to pre-operative therapy in both colon and rectal cancer. Outcomes for low rectal cancer and colon cancer could be improved by surgical education programmes backed up by pathological audit. Tumour cell density could be introduced as a new prognostic marker and could be used to define the degree of response to pre-operative treatment in colorectal cancer.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:549772 |
| Date | January 2011 |
| Creators | West, Nicholas Paul |
| Publisher | University of Leeds |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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