Abstracts
2000 Digestive Disease Week

# 2239 Endoscopic Transanal Resection Provides Palliation Equivalent to Transabdominal Resection in Patients with Metastatic Rectal Adenocarcinoma.
Herbert Chen, Bruce D. George, Howard S. Kaufman, Mohammad B. Malaki, Neil Mortensen, Michael G. Kettlewell, Baltimore, MD, Oxford, United Kingdom

Patients with metastatic rectal cancer precluding curative anterior resection (AR) or abdominoperineal resection (APR) can require palliation for impending obstruction. AR/APR is often not optimal because of the associated operative morbidity. Endoscopic Transanal Resection (ETAR) has been used for excision of select rectal lesions. To determine if ETAR provides palliation equivalent to AR or APR, we reviewed the outcomes of 49 patients with rectal adenocarcinoma and unresectable liver metastases (mean age 69±2, 75% male) who required palliatve intervention between 1/89 and 7/96. Of these 49, 24 patients had ETAR: intralumenal tumor was resected using the urologic resectoscope to achieve a hemostatic, patent lumen. The outcomes of these patients were compared to those of the other 25 who had palliative AR or APR over the same period. The median distance of the tumors from the anal verge was similar (5 cm, range 1-15 cm). ETAR patients had a higher percentage of poorly differentiated tumors (%POOR) and higher pre-operative alkaline phosphatase (APHOS) values, suggesting more aggressive disease and greater hepatic tumor burden, respectively. Despite these differences, survival and %life spent outside the hospital (%OUT) were similar between the groups. The median number of debulking procedures required in the 24 ETAR patients was 2 (range 1-17). Resections in the 25 AR/APR patients included 20 ARs, 2 APRs, and 3 Hartman procedures. There was a trend toward more stomas in the AR/ APR group. Importantly, morbidity was significantly higher in the AR/APR patients. In conclusion, ETAR is a safe alternative for the palliaton of incurable rectal tumors. Compared to transabdominal resection, ETAR provides equivalent palliation as measured by survival and time spent outside the hospital, with a lower stoma rate and signifcantly less morbidity. Therefore, in select patients with widely metastatic rectal adenocarcinoma, ETAR is an important, palliative option.