Endoscopic laser therapy as an alternative to palliative surgery for adenocarcinoma of the rectum--comparison of costs and complications.

Endoscopic laser therapy has been used as an alternative to surgery for rectal cancer in certain patients with metastases or at high surgical risk. This report analyzes 35 patients undergoing surgery and 21 undergoing laser therapy for rectal cancer. The cost of treatment was compared as well as the length of hospital stay, intensive care stay, complications, and survival. In the surgical patients, complications, length of stay, and intensive care stay were all significantly greater than for patients treated by endoscopic laser. Mean total cost for surgery was $23,156 compared with $5333 for inpatient laser treatment (p less than 0.001) and $2263 for outpatient laser treatment (p less than 0.001). Lifetime cost calculated in patients with metastases treated by surgery was $22,900 compared with $12,154 for laser therapy (p less than 0.05). Mean survival in patients with metastases was 28 weeks in the surgery group and 36 weeks for laser treatment. We conclude that the cost of endoscopic laser therapy is significantly less, and that hospital stay, intensive care time, and complications are significantly greater in patients undergoing palliative surgery for rectal cancer.