BRIEF REPORT Palliative endoscopic trans-anal resection of advanced rectosigmoid carcinoma C. L. Donohoe • A. E. Brannigan • P. R. O’Connell Received: 25 September 2009 / Accepted: 4 October 2010 / Published online: 17 October 2010 Ó Royal Academy of Medicine in Ireland 2010 Abstract There is no consensus on optimal treatment of patients with rectosigmoid cancer and unresectable metastatic disease. This is a retrospective review of all patients who underwent palliative endoscopic trans-anal resection (ETAR) of rectosigmoid cancer over a 10-year period. Fourteen patients (11 male) with a mean age 69.7 years (range 51–86) underwent ETAR; 11 for rectal tumours and 3 for rectosig- moid tumours. Indications included tenesmus (5), trouble- some bleeding (6), mucous discharge (1) and obstructed defaecation (8). The number of treatment episodes varied from 1 to 4 (median 1). The symptom-free interval was mean 6.25 months (range 2–15). Eight patients had lifelong relief of symptoms and four patients are currently symptom free. There were two short-term failures treated with stenting (1) and abdominoperineal resection (1). There were no immediate post-treatment complications. One patient developed increasing incontinence and another pelvic pain after ETAR attributable to local tumour infiltration. ETAR provides a convenient and safe method of palliation for patients with local symptoms of advanced rectosigmoid carcinoma. Keywords Metastatic rectal carcinoma Á Endoscopic trans-anal resection Á Palliative resection Introduction Approximately one-third of patients diagnosed with rectal cancer have metastases at presentation. There is substantial morbidity and mortality associated with resection of pelvic tumours; reported complication rates can be 45% in both open and laparoscopic treatment groups and there is an operative mortality of approximately 5% [1]. In the case of patients with multiple metastases, and thus poor prognosis, such radical pelvic resections may not be the most suitable means of palliation of symptoms due to the primary rectal lesion. Recent improvements in survival with new che- motherapeutic regimens for metastatic colorectal cancer treatment have meant that local symptom palliation has become increasingly important. The median survival has doubled from approximately 11 to 12 months to over 2 years [2, 3]. Thus for certain patients with incurable rectal cancer, there is a potentially important role for other procedures to palliate symptoms related to the rectal tumour. This retrospective review seeks to describe the experience of one centre using a trans-anal approach to debulk rectal tumours and thus palliate symptoms of rectal cancer that has become locally symptomatic. The primary outcome analysed is lifelong relief of local symptoms with secondary outcomes including further procedures required, procedure-related morbidity and duration of symptoms relief. Methods Prospectively collected operating records of the Depart- ment of Colorectal Surgery over a 10-year period from 1997 until 2007 were reviewed. Theatre records and hos- pital computerised inpatient records were cross-referenced. The charts of any potential cases were reviewed. Cases included in the study were patients with metastatic or un- resectable rectosigmoid tumours who underwent trans-anal resection of tumour. Patients with benign lesions or small C. L. Donohoe (&) Á A. E. Brannigan Á P. R. O’Connell Department of Colorectal Surgery, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland e-mail: donohoe.claire@gmail.com 123 Ir J Med Sci (2011) 180:541–544 DOI 10.1007/s11845-010-0614-z