Palliation of carcinoma of the rectum using the urologic resectoscope

Thirty percent to 40% of patients with rectal cancer are not candidates for aggressive surgery because of distant metastases, extensive local tumor infiltration, poor general condition, or refusal of the patient. The aim of this study was to report the results of endoscopic transanal resection (ETAR) using a urologic resectoscope for the palliative treatment of rectal carcinoma.

This study included 46 consecutive patients who underwent ETAR for rectal adenocarcinoma between October 1992 and October 2000. All patients had histologically confirmed adenocarcinoma. None of the patients were candidates for curative surgery. A retrospective evaluation of the outcome of ETAR was performed.

Forty-six consecutive patients (25 men and 21 women), with a median age of 84 years (range, 57-92 years), underwent 76 ETARs. Twenty-four patients (52%) had locally advanced rectal cancer with a tumor length of more than 5 cm. The tumor involved the anterior rectal wall in 52 ETARs. Seventeen patients (37%) required more than one procedure. Median operating time was 49 min (range, 15-120 min). The morbidity rate was 8% (n = 6); perforation of the rectum occurred in 1 patient (2%) during an iterative ETAR. The mortality rate was 2%. The median postoperative stay was 5.5 days (range, 3-16 days). Symptomatic relief was achieved in 87% of patients. Colostomy was performed in 8 cases, with a median interval of 7 months (range, 3-12 months) after the first ETAR and after a median of 2 ETARs (range, 1-3). The median survival time was 14 months (range, 0-62 months); 40 patients died. The survival rate at 1, 2, and 5 years was 54%, 31.6%, and 5%, respectively.

ETAR is a simple, minimally invasive, and economic method that should be part of palliative treatment for patients with rectal carcinoma. ETAR is a useful addition to the surgeon's armamentarium in the multidisciplinary approach of advanced rectal cancer together with laser destruction, stent implantation, and external beam radiotherapy. All these treatments must be evaluated not only in term of lumen patency or stoma rate, but also from the quality of life standpoint.