Endoscopic laser treatment for rectosigmoid villous adenoma: factors affecting the results.

Endoscopic laser treatment is reported in 264 patients with benign rectosigmoid villous adenomas revealed by biopsy. Patients include 100 who had contraindications to surgery, 60 who had a tumor recurrence after a nonlaser treatment, 101 for whom surgical resection appeared to be too drastic for a tumor found benign on biopsy, and 3 who refused surgery. Two types of lasers were used: the Nd:YAG and the argon laser. In some patients, both lasers were used. Treatment was completed in 226 patients. Total tumor destruction was attained in 92% of them, a carcinoma was detected in 7% on biopsy specimens obtained during laser treatment, and benign villous tissue persisted in 1%. During the average 25.9-mo follow-up period of the patients with total tumor destruction, 13% had a tumor recurrence. Treatment was well-tolerated with no major complications. The circumferential extension of the tumor base was the only factor affecting the duration of treatment, and the rate of complications. The recurrence rate after initial treatment was higher in patients treated for a recurrence after a previous nonlaser treatment than in patients treated only by laser (p = 0.04). It was also higher when the initial histology was low-grade dysplasia than if it was high-grade dysplasia (p = 0.017) and when the tumor was located in the lower or middle rectum as opposed to the upper rectum or sigmoid (p = 0.04). We estimated that the direct cost of laser treatments was 28%-40% of the surgery charges for lesions of identical size in our hospital and 31%-69% at UCLA Center for the Health Sciences. Because treatment is long and difficult and the cancer rate is high, endoscopic laser for patients with a circumferential villous adenoma should be limited to nonsurgical candidates. The risk of a fatal complication after surgery has to be balanced against the risk of undetected carcinoma in the other patients and the indication for endoscopic laser treatment should be discussed case by case.