Staged delivery of Nd:YAG laser therapy for palliation of advanced rectal carcinoma

PURPOSE: This study was designed to assess the degree of symptom relief, complication rate, and survival time of patients who undergo palliation with the neodymium-yttrium aluminum garnet (Nd:YAG) laser for advanced rectal cancer. METHODS: Charts of 41 consecutive patients with advanced rectal cancer treated by this method were reviewed. RESULTS: Thirty-three patients received laser treatment for a primary tumor, and eight received laser palliation for local recurrence following previous surgery. Mean number of treatments delivered was 2 (range, 1-6) for patients with a primary lesion and 2 (range, 1-4) for those patients with local recurrence. In patients in whom more than one delivery was required, subsequent procedures were deferred for more than six weeks. Morbidity rate was 2 percent, with no procedure-related mortality. Median survival time was 19 (range, 1-60) months for patients with a primary tumor and 7 (range, 3-38) months for patients with local recurrence. Four patients subsequently elected to undergo palliative surgery, and five other patients had a loop colostomy fanned because of large-bowel obstruction after a mean of 24 (range, 18-41) months. Nd:YAG laser treatment offered adequate laser palliation for 78 percent of patients in this series. However, patients who survive for more than 24 months after their first laser treatment are more likely to require palliative surgery. CONCLUSIONS: The majority of patients undergoing laser ablation for palliation do not require large numbers of treatment sessions. By delaying the interval between treatments, morbidity and mortality rates are negligible. Most patients avoid a stoma or defer the dare of requiring one before their death with this therapy.