The role of pre-resectional laser recanalization for obstructing carcinomas of the colon and rectum.
The Nd:YAG laser has proved its efficacy for recanalizing obstructing lesions throughout the gastrointestinal tract. In a preliminary report using the Nd:YAG laser as a pre-resectional treatment for functionally obstructing colorectal carcinoma we showed that this modality accomplished good decompression, allowing for formal bowel preparation, a definitive one-stage operation with no increased mortality or morbidity, and that the use of the Nd:YAG laser was significantly cost-effective. Our cumulative experience from 1985 to 1988 includes 11 patients; nine underwent pre-resection laser therapy followed by primary resection and anastomosis, and two underwent abdominoperineal resection. Tumors were located above the peritoneal reflection in nine patients and below in two patients. All patients had orthograde bowel preparation with Golytley the day after laser therapy and underwent definitive surgery. There were no wound or intra-abdominal infections or postoperative fatalities. These 11 laser-treated patients were compared with age-matched controls who had undergone earlier colonic diversion. No significant differences were noted for age, sex, tumor location or differentiation, stage, or overall survival. Comparisons between laser-treated patients and controls for the preoperative length of stay and total length of stay were significantly different (p = 0.002 and p = 0.001, respectively). When comparing laser-treated patients and controls, preoperative and total hospital costs were significantly different (p = 0.003 and p = 0.01). We have found that pre-resectional laser recanalization has allowed for primary resection and anastomosis in patients who have obstructing left colon and rectal carcinomas without compromising patient safety.
Eckhauser
M L
ML
Department of Surgery, Case Western Reserve University, Cleveland Metropolitan General Hospital, Ohio 44109.
Imbembo
A L
AL
Mansour
E G
EG
D002277:Carcinoma / Q000601:surgery / Q000628:therapy*; D003110:Colonic Neoplasms / Q000601:surgery / Q000628:therapy*; D003125:Colostomy; D003365:Costs and Cost Analysis; D006760:Hospitalization / Q000191:economics; D006801:Humans; D053685:Laser Therapy; D007902:Length of Stay; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000601:surgery / Q000628:therapy*