Endoscopic laser therapy in colorectal carcinoma

Although a variety of surgical and nonsurgical techniques are available to palliate the symptoms of advanced colorectal carcinoma, the ideal approach remains undetermined. Such an approach must include efficacy, safety, convenience, and cost effectiveness. While much remains to be learned about the role of lasers in the management of colorectal carcinoma, endoscopic laser therapy fulfills many of the requirements of an ideal palliative therapy. Although differences in approaches and techniques exist, most investigators worldwide have achieved similar results with the Nd:YAG laser. International results and our own experience show that the laser is highly effective, with success rates approaching 90 per cent. The complications of laser therapy have included bleeding, perforation, abscess, and fistula formation as well as post-laser stricturing with an overall rate of 6 per cent. Since the procedure can be done as an outpatient and involves minimal preparation, endoscopic laser therapy certainly is a convenient form of palliative therapy. In times of increasing cost containment, analysis has been done to determine the cost effectiveness of laser therapy compared with abdominal perineal resection. Mellow and McCoy, using data from a private university affiliated hospital in the southwestern United States, have shown the cost of an abdominal perineal resection is nearly five times that of initial therapy with the Nd:YAG laser. Analysis of laser costs for both initial inpatient and outpatient therapy are presented in Table 6. Because follow-up laser treatments are required at 8- to 10-week intervals, an additional five to seven treatments can be anticipated in the following year. Presuming a median survival of 12 months, the total lifetime cost for outpatient laser therapy is less than half the overall cost of abdominal perineal resection. Endoscopic laser therapy has emerged as an excellent palliative therapy for advanced colorectal carcinoma. Unfortunately, we have reached a plateau in our clinical understanding and utilization of the Nd:YAG laser for vaporization and coagulation of tumors. The continued growth of laser applications will be dependent on better understanding of the fundamentals of the laser tissue interaction. By expanding knowledge of optical and thermal properties of tissue, we will be able to explore the utilization of new wavelengths and their application to ablation, coagulation, and excision. The use of dyes that would be taken up selectively by malignant tissue may help identify and allow more effective ablation of tissue.(ABSTRACT TRUNCATED AT 400 WORDS)