Background: In cases of inoperable colorectal cancer .palliative resection provides good relief of local symptoms but the
mortality can be as high as 21%. A simple alternative is a proximal diverting colostomy, which only relieves symptoms due to obstruction & often involves a prolonged recovery period, encroaching on an already limited prognosis. Endoscopic alternatives including laser ablation has a considerable rate of complications . Argon plasma coagulation (APC) has been developed for flexible endoscopic application.
APC is a new mode of non-contact electrocoagulation where high-frequency energy is transmitted to tissue by an ionized gas (argon plasma).
Aim of the work: This study focuses on the use of Argon Plasma Coagulator (APC) [N.B. which is not a laser] as a new
modality in the management of inoperable colorectal cancer.
Patient & method: From January 1998 to March 2000, 16patients with colorectal lesions were referred for treatment with endoscopic Argon Plasma Coagulator (APC). There were 10 males & 6 females, the mean age of 64±6 years They were 13 patients with rectal carcinoma and 3 patients with sigmoid colon carcinoma. Biopsy samples were obtained from all patients and examined histologically. Patients were divided into two groups by the indications for Argon Plasma Coagulator(APC) treatment .Tumor factors included distant metastases, local unresectable recurrent disease these patients comprised (Group A). There were 13 patients in (Group A), of whom 6 had locally unresectable recurrent rectal carcinoma, 7 had distant liver
metastases .Host factors included 3 patients and was named (Group B) they had advanced age(1 case), refusal to undergo surgery (1 case), or poor surgical risk due to underlying medical illnesses (1 case) .
Results: The number of Argon Plasma Coagulator(APC) treatments ranged from 2 to nine , with a mean of 4.0 . The total
duration of the treatments ranged from 30 to 90 minutes, with a mean of 45 minutes . Each patient had one or more symptom or sign; Blood loss was seen in 12 cases & was completely controlled in eight (66.7%). before endoscopic recanalization could be achieved & was reduced in four patients (33.3%).Obstructive symptoms relieved in 5 out of 6 (83.3%).One patient developed complete obstruction before recanalisation could be achieved and needed urgent colostomy. In the ten patients with diarrhora bowel function returned to close to normal in 7 (70%) and was helped to great extent in the other three.
Faecal incontinence was almost completely controlled in 3 out of four (75%). Out of the 7 patients who complained of
tenesmus relief was achieved after treatment in 5 patients(71.4%) and partial relief in two. Average hospital stay of 14 days per patient (range 7-31 days) to complete therapy. Argon Plasma Coagulator(APC) palliation provided satisfactory control of local symptoms in 14 of 16 (87.5%).
Conclusion: Argon Plasma Coagulator (APC) is an effective form of palliative treatment for rectal carcinoma in high-risk
surgical patients and in patients with incurable disease.