Diseases of the Colon & Rectum

, Volume 36, Issue 4, pp 377–382 | Cite as

Comparison between endoscopic laser and different surgical treatments for palliation of advanced rectal cancer

  • W. Tacke
  • S. Paech
  • W. Kruis
  • H. Stuetzer
  • J. M. Mueller
  • D. J. Ziegenhagen
  • E. Zehnter
Original Contributions
  • 11 Downloads

Abstract

The results of different treatment modalities in 196 patients with rectal carcinoma were analyzed. Patients were treated by palliative endoscopic laser therapy (n=37), palliative surgery (n=42), and curative surgery (n=117). Laser therapy was successful for recanalization of the stenosis with 1.3 (range, one to five) sessions. Bleeding stopped always after a single session. If necessary, treatment was repeated monthly. Good results were seen in 35/37 patients (95 percent). They received an average of four sessions during their remaining lifetime, the median of which was eight months. No morbidity and no therapy-related mortality occurred. Palliative surgery (expanded and restricted resections) showed good results in 41/42 patients (98 percent). Morbidity was 3/42 (7 percent); mortality was 1/42 (2 percent). The median survival was 14 months for local surgical treatment and 6.3 months for deep anterior rectal resection and for abdominoperineal (Dixon's) resection. No significant difference (P=0.15) in survival times between the palliatively treated patient groups could be detected. Survival prognosis was determined by tumor stage and outcome. In the curative (outcome R0) resection patients, morbidity and mortality were each 9/117 (8 percent). The threeyear survival rate was 80 percent. If curative resection is impossible, laser therapy should be considered as an alternative to palliative surgery because of less hospitalization and seemingly less side effects. The decision on the kind of palliation in patients with rectal carcinoma should be made with regard to the patient's quality of life.

Key words

Rectal carcinoma Laser therapy Palliative surgery Survival time 

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References

  1. 1.
    Brunetaud JM, Manoury V, Cochelard D, Cortot A, Paris JC. Laser palliation for rectosigmoid cancers. Int J Colorectal Dis 1989;4:6–8.PubMedGoogle Scholar
  2. 2.
    Cutsem van E, Boonen A, Gebeos K,et al. Risk factors which determine the long term outcome of neodymium-YAG laser palliation of colorectal carcinoma. Int J Colorectal Dis 1989;4:9–11.PubMedGoogle Scholar
  3. 3.
    Krasner N. Laser therapy in the management of benign and malignant tumors in the colon and rectum. Int J Colorectal Dis 1989;4:2–5.PubMedGoogle Scholar
  4. 4.
    Walfish S, Stein H, Ball S. Use of Nd-YAG laser ablation in colorectal obstruction and palliation in high risk patients. Dis Colon Rectum 1989;32:1060–4.PubMedGoogle Scholar
  5. 5.
    Joffe J, Gordon PH. Palliative resection for colorectal carcinoma. Dis Colon Rectum 1981;24:355–60.PubMedGoogle Scholar
  6. 6.
    Johnson WR, MacDermot FT, Pihl E, Milne BJ, Price AB, Hughes ER. Palliative operative management in rectal carcinoma. Dis Colon Rectum 1981;24:606–9.PubMedGoogle Scholar
  7. 7.
    Mathus-Vliegen EM, Tytgat GN. Analysis of failures and complications of neodymium-YAG-laser photocoagulation in gastrointestinal tract tumors. Endoscopy 1990;22:17–23.Google Scholar
  8. 8.
    Schildberg FW, Meyer G. Palliative operationsverfahren beim fortgeschrittenen coloncarcinom. Chirurg 1988;59:625–33.PubMedGoogle Scholar
  9. 9.
    Bowers JH, Dixon JA. Laser palliation of gastrointestinal cancers. Lasers Surg Med 1984;4:138–42.Google Scholar
  10. 10.
    Schumpelick V, Truong S, Kupczyk-Joeris D. Stellenwert der kryo-, elektro- und laser-therapie. Chirurg 1988;59:639–46.PubMedGoogle Scholar
  11. 11.
    Bown SG, Barr H, Matthewson K,et al. Endoscopic treatment of inoperable colorectal cancers with the Nd-YAG laser. Br J Surg 1985;73:949–52.Google Scholar
  12. 12.
    Labenz J, Boersch G. Lasertherapie im unteren gastrointestinaltrakt. Ein Erfahrungsbericht. Med Klin 1989;84:479–82.PubMedGoogle Scholar
  13. 13.
    Dixon CF. Anterior resection for malignant lesions of the upper part of the rectum and lower part of the sigmoid. Ann Surg 1948;128:425–42.Google Scholar
  14. 14.
    Hermanek P. Aktuelle aspekte der neuen stadieneinteilung des colorectalen carcinoms und ihre klinischen konsequenzen. Chirurg 1989;60:1–7.Google Scholar
  15. 15.
    Buess G, Hutterer F, Theiß R, Boebel M, Isselhard W, Pichlmaier H. Das system fuer die transanale endoskopische rectumoperation. Chirurg 1984;55:677–85.PubMedGoogle Scholar
  16. 16.
    Buess G, Kipfmueller K, Ibald R,et al. Transanale endoskopische mikrochirurgie beim rectumcarcinom. Chirurg 1989;60:901–4.PubMedGoogle Scholar
  17. 17.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–81.Google Scholar
  18. 18.
    Breslow N. A generalized Kruskal-Wallis test for comparing K samples subject to unequal patterns of censorship. Biometrika 1970;57:579–94.Google Scholar
  19. 19.
    Statistisches Bundesamt Wiesbaden. Statistisches jahrbuch 1988. Kohlhammer Stuttgart, 1988.Google Scholar
  20. 20.
    Mathus-Vliegen EM, Tytgat GN. Laser photocoagulation in the palliation of colorectal malignancies. Cancer 1986;57:2212–6.PubMedGoogle Scholar
  21. 21.
    Pestana C, Reitemeier RJ, Moertel CG, Judd ES, Dockerty MB. The natural history of carcinoma of the colon and rectum. Am J Surg 1964;108:826–32.PubMedGoogle Scholar
  22. 22.
    Loizou LA, Grigg D, Boulos PB, Bown SG. Endoscopic Nd-YAG laser treatment of rectosigmoid cancer. Gut 1990;31:812–6.PubMedGoogle Scholar
  23. 23.
    Mellow MH. Endoscopic laser therapy in colorectal cancer. Int J Colorectal Dis 1989;4:12–4.PubMedGoogle Scholar
  24. 24.
    Eckhauser ML, Imbembo AL, Mansour EG. The role of pre-resectional laser recanalization for obstructing carcinomas of the colon and rectum. Surgery 1989;106:710–7.PubMedGoogle Scholar
  25. 25.
    Mellow MH. Endoscopic laser therapy as an alternative to palliative surgery for adenocarcinoma of the rectum—comparison of costs and complications. Gastrointest Endosc 1989;35:283–7.PubMedGoogle Scholar
  26. 26.
    Wodnicki H, Goldberg R, Kaplan S, Yahr WZ, Krieger L, Russin D. The laser—an alternative for palliative treatment of obstructing intraluminal lesions. Am Surg 1988;54:227–30.PubMedGoogle Scholar
  27. 27.
    Brunetaud JM, Manoury V, Ducrotte P, Cochelard D, Cortrod A, Paris JC. Palliative treatment of rectosigmoid cancer by laser endoscopic photo ablation. Gastroenterology 1987;92:663–8.PubMedGoogle Scholar
  28. 28.
    Moran MR, Rothenberger DA, Lahr CJ, Buls JG, Goldberg SM. Palliation for rectal cancer—resection? Anastomosis? Arch Surg 1987;122:640–3.PubMedGoogle Scholar
  29. 29.
    Hoffmann F, Jensen HE. Tube cecostomy for obstructing carcinoma of the left colon. Dis Colon Rectum 1984;27:24–32.PubMedGoogle Scholar
  30. 30.
    McGowan I, Barr H, Krasner N. Palliative laser therapy for inoperable rectal cancer—does it work? Cancer 1989;63:967–9.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1993

Authors and Affiliations

  • W. Tacke
    • 1
  • S. Paech
    • 2
  • W. Kruis
    • 1
  • H. Stuetzer
    • 3
  • J. M. Mueller
    • 2
  • D. J. Ziegenhagen
    • 1
  • E. Zehnter
    • 1
  1. 1.Medizinische Klinik IUniversität KölnKölnGermany
  2. 2.Chirurgische KlinikUniversität KölnKölnGermany
  3. 3.Institut für Medizinische Dokumentation und StatistikUniversität KölnKölnGermany

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