Endoscopic trans-anal resection for palliation of acutely obstructed rectal cancer in frail elderly patients

Abstract:

Obstructive carcinomas of the rectum in frail elderly patients who are not candidates for curative surgery have been traditionally treated by diverting loop colostomy. This is a retrospective evaluation of the outcome of endoscopic trans-anal resection (ETAR) for obstructed rectal cancer. Fifty-two patients with a mean age of 82 (range 76–90) years and severe concomitant disease underwent ETAR which was carried out without general anaesthesia with a 27-French two-way Iglesias resectoscope. Mean distance from the anal verge was 6 (range 4–12) cm. Obstruction was relieved in all patients with one resection, 30-day- mortality rate was 2% (myocardial infarction in a 90-year-old-patient), the 10% morbidity rate (5/52 patients) was not directly ETAR-related, and extraperitoneal rectal perforation in one patient (2%) was uneventful. In conclusion, ETAR offers good palliation in selected patients.