Endoscopic laser therapy in colorectal cancer.

Strong consideration should be given to the use of laser treatment as an alternative to surgery for palliation in patients with advanced metastatic rectal cancer. Based upon the lower cost and equivalent efficacy with surgery, laser treatment is cost-effective. In the light of this, laser treatment should be considered as an option to surgery in some patients with advanced disease. It is in these patients, however, where one must be cautious in recommending laser treatment indiscriminately. Advanced age alone should not be a sufficient reason for deciding against surgery. While it may be generally desirable to preserve the rectum, it is clear from our analysis that the presence of a rectum in no way assures satisfactory defecation. Thus, long circumferential lesions, especially those traversing the rectosigmoid angle, may be better treated with surgery even in the presence of metastatic disease, as long as the overall condition of the patient suggests reasonable survival, i.e. of more than 6 months. Any future advance in oncological therapy resulting in significant improvement in survival in patients with metastatic disease will also change the therapeutic approach to the primary tumor. Further studies are required to define which patients should be selected for endoscopic therapy. It is clear that laser treatment can eradicate totally a rectal cancer localized to the bowel wall at the time of initial treatment. Five of our patients have no evidence of residual or recurrent disease more than 12 months after laser treatment. Escourrou has reported a similar experience in a larger series.(ABSTRACT TRUNCATED AT 250 WORDS)