Endoscopic Laser Palliation for Rectal Cancer[*]

Zusammenfassung

Hintergrund: Trotz aller medizinischen Fortschritte ist die Behandlung des fortgeschrittenen Rektumkarzinoms nach wie vor eine Herausforderung. Wir untersuchten die kurzfristigen klinischen Ergebnisse, therapiebedingte Komplikationen und den Langzeitverlauf nach palliativer Lasertherapie.

Methodik: Über einen Zeitraum von 10 Jahren wurden 83 Patienten (medianes Alter: 81 ⟨46-93 Jahre⟩ 43 weiblich) wegen Rektumkarzinoms lasertherapiert. Hauptindikationen waren Obstruktion und/oder rektale Blutung. Eingesetzt wurde ein Nd:YAG-Laser.

Resultate: Kurzfristig wurden 96,4 % (80 von 83) Patienten erfolgreich behandelt. Nur eine Patientin wurde initial wegen einer unzugänglichen, hochgradigen Rektumstenose kolostomiert. Im Nachbeobachtungszeitraum mussten sich acht weitere Patienten wegen Therapieversagen (meist Rezidivobstruktionen) oder Komplikationen einem operativen Eingriff unterziehen (Langzeiterfolg: 86,7 %). Die mediane Überlebenszeit betrug neun Monate. Patienten, die wegen Obstruktion behandelt wurden, benötigten mehr Therapiesitzungen und wurden im Verlauf häufiger palliativ operiert als Patienten mit Blutungen. Schwere Komplikationen traten bei drei Patienten (3,6 %) auf. Ein Patient starb nach Rektumperforation (therapiebedingte Gesamtmortalität: 1,2 %).

Schlussfolgerungen: Die Lasertherapie ist effektiv zur Palliation von Rektumkarzinomen mit einer hohen kurz- und langfristigen Erfolgsrate. Die Laserpalliation ist auch im Zeitalter neuerer endoskopischer Techniken, wie Metallstents, immer noch eine wertvolle Behandlungsoption.

Abstract

Objective: The treatment of advanced rectal cancer is still a challenge. We analysed the short-term success, treatment-related complications and the long-term outcome after laser palliation for rectal cancer.

Methods: Over a ten-years period eighty-three consecutive patients (median age 81 (46-94) yrs; 43 female) were treated mainly for obstructive symptoms or tumour bleeding. Laser palliation was performed using a Neodymium:Yttrium-Aluminium-Garnet (Nd:YAG) laser.

Results: The immediate overall-success rate was 96.4 % (80 of 83 patients) and only one female received a diverting colostomy because of an inaccessible high-grade rectal stenosis, initially. During follow-up, eight additional patients had to undergo surgery on their rectal cancer because of treatment failures (most of them recurrent obstruction) or complications (long-term success rate: 86.7 % (72 of 83 pts.)). The median survival period was nine months.

Patients treated for obstruction had more treatment sessions and had a higher rate of surgical palliation in comparison to those pts. therapied for bleeding. Major complications were seen in three patients (3.6 %). One patient died after rectal perforation following bougienage before laser treatment (overall mortality: 1.2 %).

Conclusion: Laser therapy is effective for the palliation of advanced rectal cancer with a high short-term and long-term success rate and only few complications. Laser treatment therefore is still a valuable alternative to newer endoscopic techniques and surgery.

Rektumkarzinom - Laser - Palliation - Endoskopie - Obstruktion - Blutung

Rectal Cancer - Laser - Palliation - Endoscopy - Obstruction - Bleeding

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1 Presented in parts at the annual meeting of the Amercian Gastroenterological Association (Digestive Disease week), San Diego 1998.