Transrectal resection of rectal cancers with the use of the urologic resectoscope is a safe, controlled technique that allows good visualization with defined limits of excision. Twenty-three patients have undergone 50 transrectal resections, with a median survival of 10.8 months. Only 1 of 22 patients required subsequent colostomy before death. Patients, followed as long as 29 months, have had good local control of tumor and excellent palliation of symptoms.
Cancer 57:563-566, 1986.
ULGURATION OF RECTAL CARCINOMAS is an estab-F lished technique in patients who are considered to be poor candidates for abdominoperineal resection of the rectum. This may include elderly patients, those with severe concomitant medical problems, and those with documented metastatic disease at the time of diagnosis. Fulguration has been presented as a reasonable alternative to abdominoperineal resection,'-" with cure of local disease reported in greater than 60% of patients so treated.' Conventional fulguration through a standard or operating proctoscope can be technically difficult and time-consuming. Tumor visualization is frequently poor due to the presence of smoke in the operative field. Identification of margins of excision is similarly compromised. We previously reported results in ten patients undergoing transrectal resection of rectal tumors (TRRRT) with the urologic resectoscope and coagulating ball.'' This method incorporates many of the benefits of local fulguration, but in addition allows resection under excellent optical conditions, which enable the surgeon to perform more complete resections in a safer, controlled environment. Results of resections in 23 patients who underwent a total of 50 procedures are summarized. Local control for periods of up to 29 months was provided. Five of nine patients without evidence of metastatic disease at diagnosis were alive (median survival, 12.4 months) without evidence of local or distant disease an average of 10 months after initial resection. Three of the four patients with local disease