Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor George J. Chang, The University of Texas, USA
- Second opponent: Professor Eva Angenete, University of Gothenburg, Sweden
- Third member and chair of the evaluation committee: Associate Professor Knut Magne Augestad, University of Oslo
Chair of the Defence
Professor Jørgen Wesche, University of Oslo
Principal Supervisor
Professor II Kjersti Flatmark, University of Oslo
Summary
The aim of rectal cancer surgery is to remove the tumour with clear resection margins (R0). Total mesorectal excision (TME) is sufficient for most patients, but when the tumour breaches the mesorectal fascia, surgery has to be extended beyond the TME plane. For this subgroup of patients, there is no common classification of tumours, margins are more often involved, and survival is inferior.
In his thesis, Arne Mide Solbakken reports the results of three clinical trials of rectal cancer patients requiring surgery beyond TME at the Radium Hospital.
The Beyond TME trial was conducted at centres in the United Kingdom and Norway specialising in surgery beyond TME. In 98 patients, an MRI classification based on pelvic compartments identified factors associated with margins and survival, and the majority of patients had R0 resection and long-term survival. The classification should be used to identify patients in need of referral to specialised centres for surgery beyond TME.
The robot study reported short-term outcomes after robot-assisted beyond TME laparoscopy in 105 patients at the Radium Hospital. With R0 resection in most patients and complication rates comparable to open surgery, the study indicated that the robot-assisted approach can replace the traditional, open approach in selected patients.
The NAVI LARRC trial evaluated feasibility of navigation-assisted surgery in 17 patients with very advanced tumours at the Radium Hospital. The majority of patients had R0 resection, and surgeons reported navigation to be feasible and useful.
Taken together, the studies in this thesis have provided opportunities for improving outcomes for rectal cancer patients with tumours involving the TME plane. At the Radium Hospital, rectal cancer patients are now staged according to compartments on MRI, three quarters of patients with tumours involving the TME plane are offered a robot-assisted approach, and navigation is used in the most advanced cases.
Additional information
Contact the research support staff.