Laser palliation for gastrointestinal malignancy

Surgical palliation of advanced gastrointestinal malignancy is often accompanied by high morbidity and limited success. To evaluate the role of ablative laser therapy in palliation, we reviewed our experience with 30 consecutive patients who presented with symptoms of obstruction, bleeding, or pain from unresectable tumors of the esophagus (20), Stomach (4), or rectum (6). Overall, 97 laser treatments were administered endoscopically with a Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser using average energy per treatment of 4525 joules. Forty per cent of the patients received their therapy as outpatients and all were given only light intravenous sedation. The symptomatic response was good to excellent in 70 per cent of patients but five (16.7%) subsequently developed recurrences requiring further laser ablation. Performance status was improved in 19 of 20 patients with esophageal cancer. Few of the gastric or colorectal cancer patients noted changes in performance status since concomitant medical illnesses often limited their overall function. There was one mortality within 30 days from esophageal tumor cachexia and two patients experienced moderately severe visceral pain. No perforation or fistulizations occurred. This experience confirms that a Nd:YAG laser photo-ablation is safe and effective when palliation is indicated for advanced cancers of the gastrointestinal tract.