The use of the Nd-YAG laser in the treatment of rectal carcinoma and adenoma.

Although radical excision remains the treatment of choice for rectal carcinoma and large rectal polyps, laser treatment of such tumours in patients unfit for surgery, as well as for those fit patients with small sessile rectal polyps, is a valid therapeutic option. In the present series 24 patients (16 males and 8 females; median age 78.5 years, range 59-91) had laser treatment--six for rectal carcinoma and 18 for benign rectal polyps. A Nd-YAG laser was used to treat all patients using either a rigid operating or a flexible sigmoidscope to gain access to the tumour. Debulking of large tumours with the diathermy snare before laser treatment was very helpful. In this series 50 to 70 watts of power for 2 to 5 s were used. Total doses of laser energy administered ranged from 414 to 26,117 joules and depended on the initial tumour size and also the amount of tumour that could be removed during preliminary debulking. There were no immediate post-treatment complications but one patient developed a rectovaginal fistula 3 months after laser treatment. Two carcinomas were completely ablated by laser treatment and the other four patients with rectal carcinoma had fair to excellent palliation. All but one of the polyps were completely cleared by laser therapy. Laser therapy seems superior to simple fulguration as three patients who had repeated fulgurations for large polyps without much success had their polyps dramatically improved by laser treatment.