Outcome assessment of developments in rectal cancer treatment: a patient and surgical perspective

Locally advanced rectal cancer is treated with chemotherapy, radiotherapy and surgery. A minority of patients (25%) have such a good response to chemo and radiotherapy, that surgery can be omitted. This is called Watch and Wait. These patients do not have to bear the significant problems that come with major abdominal surgery. This thesis investigates the outcomes of patients that ‘fail’ Watch and Wait because the tumor returns and still need surgery; regarding complications, development of the cancer and quality of life. Additionally, this thesis explores whether in this case a much more limited operation is feasible. Finally, factors that influence response to questionnaire studies are examined as these studies form the backbone of patient reported outcomes we rely upon.