contact laser avec pointes de saphir ou fibre nue a l'avantage qu'aucune insuft1a- t1on Je gaz n'est nccessaire ..... Goligher J. Surgery of the Amis,. 14. Si>chy B ...
SIXTH INTERNATIONAL COURSE ON THERAPEUTIC ENDOSCOPY
Endoscopic palliation of colorectal cancer G NUSKO, C ELL
G NUSKO, CELL Endoscopic palliation of colorectal cancer. Can J Gastroenterol 1993;7(6):466-470. Palliating colorectal cancer by endoscopy means palliating rectosigmoidal cancer. Surgical palliation is preferred in tumour stenosis located higher than the first th ird of the sigma or distal rectum with infiltration of the anal and pcrianal region. Indications for endoscopic palliation arc limi ted to incurable rectosigmoid tumours with multiple metastases, for genera l inoperability or in recurrent anastomotic cancers. There are several methods currently ava ilable for local palliative therapy. Cryotherapy is obsolete because of the acute and late bleed ing risks from the base of the tumour. Elcctrocoagualrion is feasible, however, time-consuming using the monopolar method. If the tumour is highly stenotic, auxiliary techniques con sisting of prelaser bouginage or balloon dilat ion are useful. Combination therapies with intra luminal high dose irradiation or metal stents seem to be promising, according to a few case reports. At the present time, endoscopic laser therapy is the most established palliative treatment for colorecta l cancers. Standard is the solid state n eodymium:YAG laser. Contact laser therapy with sapphire tips or hare fibre has the ad vantage that no gas insufflation is required. T his makes the procedure more comfortable for the patie nt. On the ocher ha nd, these techniques are more time-consuming than the noncontact laser irradiation. Laser therapy can be performed as an out-patient procedure. The success rate of more than 90% can be achieved with a very low complication rate of about 5%. Key Words: Colorectal cancer, Endoscopy, Palliative therapy, Recwsigmoidal cancer
Traitement palliatif endoscopique du cancer rectocolique RESUME: Le tra itemenc palliatif endoscopique du cancer rectocolique suppose un tra itement palliatif du cancer rectosigmo'idien. La chirurgie palliative est preferee clans les cas de stenose tumorale localisee plus ha ut que le premier tiers du rectum distal, avec infiltration de la region anale et perianale. Les indications Division nf Gastmi111estinll/ Endosrn/>y, De/>artment of Medicine, University Erlangen-Niimberi, ErlanJ?en, Gennany Corres/xmdence: Pri~, Doz Dr C Ell, Division of GllStrnintestina! Endoscopy, De/>llrtmenr of Medicine, University Erlange11-Niimhe1·g, Krnnkenhausstr l 2. 85 20 Erlangen, Germany. Fax (0049) 9/3 1-26/9 /
466
C
ANCERS OF THE COLON AND REC-
tum are among the leadin g causes of morbidity and mortali ty in the Western world . In the United States, 150,000 cases were diagnosed in J989 (500,000 cases worldwide), with an overall mortality of 50% ( l ). The incidence of colorectal cancer is increasing. The lifeti me risk of deve lopi ng colorectal cancer between the ages of 50 and 75 years in the United States is approximately 5%, with a 2.5% chance of dy ing from it (1) . The median age of diagnosis is 71 years and the risk inc reases with age (2). The standard treatment for cancer of the large bowel is surgical removal. Extended disease or recurrent disease is unli kely to he treatable except by palliation . Patients with advanced colorectal cancer should a lso undergo palliative resection whenever possible because resection decreases pelvic complications, ie, pelvic abscesses, sepsis and pelvic pain (3 ). The purpose of palliative treatment is to relieve symptoms, to prevent obstruction and to improve the patient's quality of life. A nonsu rgical palliative treatment is indicated if the gene ra l condition of the patient does not a llow surgery; in patients with nonresectable tumours, associated with high surgical mortality
CAN J GAsnOENTEROL VOL 7 No6 JULY/AUGUST 1993
Endoscopic palliation
J'une cmloscopie palliative se limitcnt aux tumeurs rcctosigmo'idiennes avec mecasrascs multiples, clans les cas gcnera lemcnr innpcrables ou dans Ics cas de cnncer anastomoses inopcrables. Diverses techniques sont offertes a l'heurc actuellc en traitemenc palliatif. La cryotherapie est dcpassee a cause des risques aigus et tarchy B, Remi ngton JI I, S,)bel SH. Treatment of recrnl carcinom,1s by means of endocavirnry irrndiarinn: A progre~, reporl. Cancer 1980;46: l 957-61. Papillon J. New pro,pecl, in the conservative trealmelll of rectal cancer. Dis Colon Recwm l 984;27:695- 700. Papillnn J. Radimiun t hernpy 111 the con,ervative mnnagemenr of c,mcen, o( the l(>W rectum and anal canal. Int J Cid cancers. lnt J Colorecl Dis 1989;4:6-8. 3'3. Brunetaud JM, Maunoury V, Ducrotrc P, Cochclard D, Cortot A, P:1ris JC. Palliative treatment of rectosigmoid carcinoma by lm,er endo,copic phntoablation. Gastnicntcrolngy t 987;92:663-8. 34. Mathus-Vliegen EM! I, Tytgat GNJ. Nd , YAG laser phntocoagula1 ion in gastroentenilogy: Irs role in palliation uf colorecu, I rnncer. Lasers MeJ Sci t 986;1 :75-80. 35. Mathu,-Vl iegen EMH, Tytgat GNJ. Analyses of foi lures and complications of neodyni um:YAG laser photocoagulation in gastro intest inal tract tumours. Endo,copy 1990;22: 17-23. 36. Gol igher J. Surgery of the Amis, R.ecrnm anJ Colon. Lnndon: Balliere Tind all , 1984. 37. C u tsem v;in E, Boonen E, Cchocs K, ct al. Risk fa ctor~ which d etermine the long term outcome of neodymi umYAG laser pall i:1tion of colorecral carcinoma. Int J Colo n Db 1989;4:9, I I. 38. McGowan I, Barr 11, Krasner N. Pall iative laser therapy for inoperable rectnl cancer - does it work 1 A prospective study of quality of life. Cancer 1989;63:967-9. 39. Mellow Ml l. Endoscopic la,er thernpy as an alternative to palliative surgery for adenocarcinoma of rhc rectum - comp,irison of costs and complication,. Gastro inte>l EnJnsc I 989; 35:283-7.
J GASTROENTEROL VOi 7 No6JULY/Aut,UST 1993
MEDIATORS of
INFLAMMATION
The Scientific World Journal Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Gastroenterology Research and Practice Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Journal of
Hindawi Publishing Corporation http://www.hindawi.com
Diabetes Research Volume 2014
Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
International Journal of
Journal of
Endocrinology
Immunology Research Hindawi Publishing Corporation http://www.hindawi.com
Disease Markers
Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Volume 2014
Submit your manuscripts at http://www.hindawi.com BioMed Research International
PPAR Research Hindawi Publishing Corporation http://www.hindawi.com
Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Volume 2014
Journal of
Obesity
Journal of
Ophthalmology Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Evidence-Based Complementary and Alternative Medicine
Stem Cells International Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Journal of
Oncology Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Parkinson’s Disease
Computational and Mathematical Methods in Medicine Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
AIDS
Behavioural Neurology Hindawi Publishing Corporation http://www.hindawi.com
Research and Treatment Volume 2014
Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
Oxidative Medicine and Cellular Longevity Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
