Endoscopic laser palliation for rectal cancer-- therapeutic outcome and complications in eighty-three consecutive patients.
OBJECTIVE
The treatment of advanced rectal cancer is still a challenge. We analysed the short-term success, treatment-related complications and the long-term outcome after laser palliation for rectal cancer.


METHODS
Over a ten-years period eighty-three consecutive patients (median age 81 (46-94) yrs; 43 female) were treated mainly for obstructive symptoms or tumour bleeding. Laser palliation was performed using a Neodymium:Yttrium-Aluminium-Garnet (Nd:YAG) laser.


RESULTS
The immediate overall-success rate was 96.4 % (80 of 83 patients) and only one female received a diverting colostomy because of an inaccessible high-grade rectal stenosis, initially. During follow-up, eight additional patients had to undergo surgery on their rectal cancer because of treatment failures (most of them recurrent obstruction) or complications (long-term success rate: 86.7 % (72 of 83 pts.)). The median survival period was nine months. Patients treated for obstruction had more treatment sessions and had a higher rate of surgical palliation in comparison to those pts. therapied for bleeding. Major complications were seen in three patients (3.6 %). One patient died after rectal perforation following bougienage before laser treatment (overall mortality: 1.2 %).


CONCLUSIONS
Laser therapy is effective for the palliation of advanced rectal cancer with a high short-term and long-term success rate and only few complications. Laser treatment therefore is still a valuable alternative to newer endoscopic techniques and surgery.
Jakobs
R
R
Department of Medicine C (Gastroenterology); Klinikum der Stadt Ludwigshafen gGmbH, Academic teaching Hospital of the University of Mainz, Ludwigshafen, Germany.
Miola
J
J
Eickhoff
A
A
Adamek
H E
HE
Riemann
J F
JF
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007415:Intestinal Obstruction / Q000401:mortality / Q000473:pathology / Q000601:surgery; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011351:Proctoscopy; D012002:Rectal Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000401:mortality; D015996:Survival Rate