Laser ablation of early colorectal malignancy

Between November 1979 and July 1992, 35 patients with early colon cancer were treated with a non-contact, high power Nd: YAG CW laser. Criteria for classification as early colon cancer were the presence of adenocarcinoma in deep biopsies of flat tissue or within and underneath the polypectomy resection margin, and evidence on endosonography of infiltration into but not beyond the submucosal layer without evidence of lymph node involvement. Fifteen patients fulfilled both requirements, another 15 had been treated in the presonographic period, and 5 had abnormal endosonographic findings but inconclusive biopsies. Laser treatment was evaluable in 30 patients. Complete eradication was achieved in 28 patients, after a median of two treatments given over a median period of 42 days without complications. No recurrence was seen in a median follow-up period of three years. The cumulative probability of survival at one, two and five years was 94%, 84% and 62%, respectively, in an elderly and medically compromised patient group (median age 74 years). As complete, fast and safe eradication is possible in over 90% of cases, curative laser treatment should be considered in highly selected cases with limited wall invasion, as established at endosonography.