[Treatment of rectal cancer with the neodymium-YAG laser]

Fifty-two non-surgical patients presenting rectal carcinoma were treated initially with palliative laser Nd-YAG. Their mean age was 79 years (49-92). Thirty patients had a severe diarrheic syndrome, associated with tenesmus in 27 cases; 20 patients had repeated hematochezia (5 presenting diarrhea as well); 6 had obstructive signs and one was symptom-free. Thirty lesions were less than 6 cm in size, 12 were between 7 and 10 cm and 10 were greater than 10 cm. Twenty-two lesions were circumferential. During the study period, 444 laser sessions were performed (mean 8.5/patient). Bleeding was stopped in all cases during the first session. Improvement of the diarrheic syndrome, obtained in 24 of the 30 patients, was correlated with the reduction of tumor volume. Tenesmus disappeared after 1 or 2 sessions, regardless of whether the tumor was destroyed or not. Failure was observed in 6 patients with lesions larger than 10 cm. Colostomy was avoided in 4 of the 6 obstructed patients. Negative biopsies were repeatedly obtained after mucosal repair in 9 patients with small lesions (less than 6 cm). Mean follow-up is now 8.2 months for the patients still alive. Complications were: 2 cicatricial stenosis and 3 hemorrhages (one required blood transfusion). Laser Nd-YAG allows palliative but conservative and effective treatment for rectal cancers. Although complete destruction is possible for small lesions, indications with curative intent are currently limited to patients with major contraindications to surgery.