Endoscopic trans-anal resection for palliation of acutely obstructed rectal cancer in frail elderly patients

Abstract

Obstructive carcinomas of the rectum in frail elderly patients who are not candidates for curative surgery have been traditionally treated by diverting loop colostomy. This is a retrospective evaluation of the outcome of endoscopic trans-anal resection (ETAR) for obstructed rectal cancer. Fifty-two patients with a mean age of 82 (range 76-90) years and severe concomitant disease underwent ETAR which was carried out without general anaesthesia with a 27-French two-way Iglesias resectoscope. Mean distance from the anal verge was 6 (range 4-12) cm and mean intraluminal tumour length 4 (range 3-6) cm. Obstruction was relieved in all patients with one resection, 30-day mortality rate was 2% (myocardial infarction in a 90-year-old patient), the 10% morbidity rate (5/52 patients) was not directly ETAR-related, and extraperitoneal rectal perforation in one patient (2%) was uneventful. In conclusion, ETAR offers good palliation in selected patients.