Endoscopic transanal resection provides palliation equivalent to transabdominal resection in patients with metastatic rectal cancer

Patients with metastatic rectal cancer precluding curative low anterior res ection (LAR) or abdominoperineal resection (APR) can require palliation for impending obstruction. LAR or APR is frequently not optimal because of the associated operative morbidity. Lesser procedures such as diverting colost omy require patients to live with a permanent stoma. Endoscopic transanal r esection (ETAR) has been used for excision of rectal lesions. To determine whether ETAR provides palliation equivalent to LAR or APR, we reviewed the outcomes of 49 patients with rectal adenocarcinoma and unresectable liver m etastases who required palliative intervention between January; 1989 and Ju ly 1996. Of these 49 patients, 24 underwent ETAR; the intraluminal tumor wa s resected using the urologic resectoscope to achieve a hemostatic, patent lumen. The outcomes of these patients were compared to those of the other 2 5 patients who had palliative LAR, APR, or a Hartmann procedure during the same period. The median distance of the tumors from the anal verge was simi lar (5 cm; range 1 to 15 cm). ETAR patients had a higher percentage of poor ly differentiated tumors (35% vs. 6%, P = 0.034) and higher preoperative al kaline phosphatase values (478 +/- 75 mg/dl vs. 231 +/- 24 mg/dl; P <0.015) , suggesting more aggressive disease and greater hepatic tumor burden, resp ectively. Despite these differences, overall survival and time spent outsid e the hospital were similar in the two groups. The median number of debulki ng procedures required in the 24 ETAR patients was two (range 1 to 17). Res ections in the 25 LAR/APR patients included LAR in 20, APR in two, and Hart mann procedures in three. There was a trend toward more stomas in the LAR/A PR group (28% vs. 17%). More important, morbidity was significantly higher in the LAR/APR patients (24% vs. 4%; P = 0.019). Ln conclusion, ETAR is a s afe alternative for the palliation of incurable rectal tumors. Compared to transabdominal resection, ETAR provides equivalent palliation as measured b y survival and proportion of the patient's life spent outside the hospital, with a lower stoma rate and significantly less morbidity. Therefore, in se lect patients with metastatic rectal cancer, ETAR is an important palliativ e option.