Laser palliation for colorectal carcinoma
Article Abstract:
The main treatment for colorectal (intestinal or rectal) cancer is surgery. However, some patients are unable to undergo surgery because of advanced age or underlying medical conditions; some patients are considered incurable at the time of diagnosis because of extensive cancer spread. These patients need palliation (symptomatic relief) from discomfort caused by intestinal obstruction, diarrhea, constipation, bleeding, pain, anal sphincter spasms, and rectal discharge. Palliative surgery has a mortality rate of between 5 and 10 percent, and a complication rate of 10 to 20 percent. A report is presented of endoscopic laser treatment used for palliation in 27 patients with colorectal cancer. Average patient age was 75 years; 25 patients had rectal cancer and two patients had cancer of the sigmoid colon (lower portion of the descending large intestine). The single most common symptom was rectal bleeding (20 patients). Ten patients did not undergo surgery due to advanced age, unwillingness to undergo surgery, or poor medical risk because of underlying medical conditions. The remaining 17 patients had tumor factors, such as distant spread of cancer and unresectable disease, or in situ cancer, which did not justify extensive surgery. Patients were treated with Nd:YAG laser given by means of a colonoscope (an illuminated optic instrument used to visualize an interior body cavity). Patients received an average of three laser treatments. Four patients (15 percent) had complications, such as bleeding, fecal incontinence, or obstruction. There were no treatment related deaths. Relief of symptoms was achieved in 23 of the 27 patients (85 percent). It is concluded that laser treatment provides effective symptomatic relief for patients with colorectal cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Surgery
Subject: Health
ISSN: 0002-9610
Year: 1991
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Palliative operations for pancreatic carcinoma
Article Abstract:
By the time pancreatic cancer is diagnosed, it is usually too late to cure the disease by removing the cancer surgically. Therefore, if surgery is performed it is usually palliative, meaning a therapy designed to relieve the patient's discomfort as much as possible but not expected to cure the disease. There is controversy over how to achieve the best palliation. A review of the medical records of 142 patients who underwent palliative operations for pancreatic cancer was undertaken in order to determine the best method of palliation. The goal of palliation is to avoid local complications of the disease. Some form of biliary bypass procedure was performed on 122 of the 142 patients. It was found that direct joining of the gallbladder duct to the intestine (specifically to the duodenum) provided the most desirable results. This procedure was associated with shorter operation time and reduced hospital stay. The incidence of biliary sepsis (infection) was significantly less than with other forms of biliary bypass. Gastrojejunostomy (joining of the stomach to the second portion of the small intestine) was performed for 74 patients. The blood loss, operation time and hospital stay were similar to that of patients who did not undergo stomach bypass. About 10 percent of patients who did not have stomach bypass subsequently developed obstruction at the outlet of the stomach. The authors therefore recommended that gastric bypass be frequently used in the palliative treatment for pancreatic cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Surgery
Subject: Health
ISSN: 0002-9610
Year: 1990
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