median survivals of 19–25 months and five-year survivals of 19–28%, which compare well with post-operative therapy.115,142,143,149,151,154–158 However, there is a potential bias introduced by the selection process. Randomised controlled trials proving an overall benefit of neoadjuvant therapy are lacking and the risk of missing a resectable tumour due to growth during the treatment period has been proposed. A further question is whether extensive neoadjuvant therapy may actually cause downstaging, as has been claimed in some studies.156,157,159,160
Further comparative studies between
neoadjuvant and adjuvant therapy are needed. Future Aspects
The improvement in post-operative morbidity and mortality due to better surgical technique and improved peri-operative management is expected to continue. One of the major factors is the early treatment of post-operative complications by a dedicated multiprofessional team (surgeon, anaesthesiologist, gastroenterologist, radiologist and specialised nurses). Substantial improvements in long-term survival
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