Sequential electrocoagulation and resection for carcinoma of the rectum.

Sequential electrocoagulation followed by resection of carcinoma of the rectum provides better survival results than have been previously obtained. More than 200 patients have been treated by this combined approach during the past ten years. The over-all five year survival rate is 67 per cent. The preferred method of treatment is sequential electrocoagulation followed by low anterior resection. When this procedure was done, 55 of the 65 patients have survived a minimum of five years. If abdominoperineal resection is necessary, the over-all survival rate is 61 per cent. The specific advantages of sequential electrocoagulation and resection are several. This procedure is safe and relatively easy to do. Electrocoagulation may be done at the time of initial biopsy as part of the preoperative evaluation. The usual interval between electrocoagulation and resection is three to five days. This may be longer in selected instances. Preoperative electrocoagulation of carcinoma of the rectum helps to prevent local recurrence on anastomoses and in the perineum. Local recurrence occurred in only 5 per cent of the patients. Electrocoagulation destroys rectal tumor cells in an area in which vascular isolation technique and wide resection of the mesentery are not possible. The efficacy of electrocoagulation in destroying tumor cells is confirmed by pathologic study of our clinical material. Combining electrocoagulation with resection may extend the limits of low anterior resection for favorable lesions allowing use of sphincter-saving procedures with less likelihood of local recurrence. Electrocoagulation, radiation therapy and surgical treatment are not mutually exclusive treatment methods. Rather, we view these modalities as complimentary in offering the potential for additive benefits.