Palliative endoscopic trans-anal resection of advanced rectosigmoid carcinoma

There is no consensus on optimal treatment of patients with rectosigmoid cancer and unresectable metastatic disease. This is a retrospective review of all patients who underwent palliative endoscopic trans-anal resection (ETAR) of rectosigmoid cancer over a 10-year period. Fourteen patients (11 male) with a mean age 69.7 years (range 51-86) underwent ETAR; 11 for rectal tumours and 3 for rectosigmoid tumours. Indications included tenesmus (5), troublesome bleeding (6), mucous discharge (1) and obstructed defaecation (8). The number of treatment episodes varied from 1 to 4 (median 1). The symptom-free interval was mean 6.25 months (range 2-15). Eight patients had lifelong relief of symptoms and four patients are currently symptom free. There were two short-term failures treated with stenting (1) and abdominoperineal resection (1). There were no immediate post-treatment complications. One patient developed increasing incontinence and another pelvic pain after ETAR attributable to local tumour infiltration. ETAR provides a convenient and safe method of palliation for patients with local symptoms of advanced rectosigmoid carcinoma.