Palliative endoscopic therapy for rectal cancer with neodymium:YAG laser

Neodymium: YAG laser has become an alternative to conventional palliative therapy for rectal cancer. Between January 1986 and December 1989, 31 patients were treated with endoscopic laser evaporation for rectal cancers with obstruction (n = 17), bleeding (n = 3) and non-obstructive luminal narrowing (n = 11). Contraindications against surgery were multiple metastases (n = 16), poor general health (n = 7), refusal by patient (n = 5) and extensive local invasion (n = 3). Laser treatment was tolerated well with an initially good response in 29 patients. Palliation could be maintained in 20 patients with laser only; two patients had an unsatisfactory control of symptoms and in eight cases a diverting colostomy was eventually required, largely due to extramural tumor growth. Complications were limited to one stenotic scar. There were no laser-related deaths. Patients survived on average 10.8 (0.1-49) months, 2-year survival was 26%. We conclude that endoscopic neodymium: YAG laser therapy is an efficient and safe palliative method to control intraluminal, obstructing or bleeding rectal cancers.