Endoscopic treatment of inoperable colorectal cancers with the Nd YAG laser.

Seventeen patients with cancers of the rectum or distal sigmoid and considered inoperable because of old age, severe concomitant disease or advanced stage of malignancy, were treated endoscopically with the Nd YAG laser. Symptoms included rectal bleeding, obstruction, diarrhoea and incontinence. Significant improvement was achieved in 15 (88 per cent) and there were no complications. The procedure was carried out with simple bowel preparation and minimal sedation and, for otherwise fit individuals, the mean total hospital stay was 6.8 days, with day case therapy sometimes possible. Three patients required further therapy for recurrent symptoms 6-8 weeks after treatment. Fourteen patients died 1-39 weeks after therapy (mean survival 15 weeks). Three are alive and free of bowel symptoms after 39-54 weeks. This technique is the only non-surgical therapy that can be used safely for lesions above the peritoneal reflection and provides palliation at least as good as electrocoagulation, cryotherapy and radiotherapy with minimal upset to these seriously ill patients.