Superiority of Nd:YAG Laser to Cryosurgery in the Treatment of Rectal Carcinoma

Laser coagulation (LC) by Nd:YAG laser and cryodestruction (CD) by insulated cryoprobe were done in 52 patients with carcinoma of the rectum (LC = 27, CD = 25). The patients were divided into four groups: group I, inoperable rectal carcinoma because of advanced stage of malignancy, severe concomitant disease, old age (LC = 14, CD = 12); group II, patient refused permanent colostomy (LC = 4, CD = 3); group III, polypoid lesion fulfilled the criteria of local excision (LC = 3, CD = 2); group TV, local recurrence after anterior resection (LC = 6, CD = 8). The mean hospital stay was 8.11 ± 5.6 days for LC and 12.8 ± 8.7 days for CD (p < 0.05). For LC minimal or no sedation was needed, but for CD general anesthesia (n = 3) was occasionally necessary. Significant improvement was achieved in 85.18% (n = 23) of cases with LC and 56% (n = 14) of cases with CD (p < 0.05). Complications after LC were mild (n = 7) to moderate (n = 3) and after CD they were moderate (n = 11) to severe (n = 2). Almost every patient with CD complained of moderate to severe discharge of malodorous necrotic tissue for a period of 2 weeks or more. In groups I, II, and IV patients with LC enjoyed a longer (81.08 ± 47.48 days) trouble-free period than those with CD (43.3 ± 13.45 days) (p < 0.001). In follow-up after 1 year, group III patients revealed no signs of recurrence following LC, but one patient treated by CD showed signs of recurrence. As a result of this study, it may be suggested that LC is superior to CD for this patient group. LC is more effective in the treatment of rectal carcinoma, and can be used safely for the lesions situated above the peritoneal reflection using a flexible endoscope.