Complications and salvage surgery following restorative and non-restorative rectal cancer resection

The surgical treatment of rectal cancer is an ongoing developing field. The number of possible surgical techniques for rectal cancer resection are expanding, dependent on tumour stage, location of the tumour, patient characteristics and patient preferences. The same applies to surgical treatment after failure of a primary anastomosis. All new, mostly minimally invasive techniques, can offer substantial advantages for the individual patient, but they are also associated with their own specific complications, of which anastomotic leakage and pelvic sepsis are the most feared sequelae. This thesis address complications, reinterventions and reoperations following non-rectum preserving rectal cancer resection. In the first part, it focusses on restorative rectal cancer resection, with creation of an anastomosis and the incidence of anastomotic leakage in the Dutch population. In the second part, non-restorative rectal cancer resection, without restoration of bowel continuity and the creation of a stoma is addressed. Low Hartmann’s resection is compared to intersphincteric abdominoperineal resection as a surgical treatment option in patients in whom bowel continuity is not desired. The third part of the thesis focusses on redo surgery following anastomotic leakage. It addresses both redo anastomosis, including surgical outcomes and functional outcomes and intersphincteric completion proctectomy. Also, the role of TAMIS in redo surgery is assessed.