S. Delikoukos • D. Zacharoulis • C. Hatzitheofilou Department of Surgery University Hospital, Larisa, Greece S. Delikoukos () 63 Rousvelt Str. Larisa 41 222, Greece E-mail: morfula@otenet.gr Introduction Abdominoperineal resection (APR) has been the standard treatment for distal rectal adenocarcinoma. With improve- ment of surgical techniques and the advent of the circular stapler, there has been a shift toward sphincter-saving low anterior resections (LAR). Despite this trend, radical exci- sion of rectal carcinomas remains a major undertaking with significant short and long term complications. These may include intraoperative bleeding, anastomotic leak, sexual and urinary dysfunction, colostomy complications and unhealed perineal wounds. These considerations have led to an increased popularity of local procedures as primary treat- ment for rectal cancer for selected patients [1]. These tech- niques include: transanal, transsphincteric or transsacral full- thickness excision, per anal submucous excision, laser treat- ment, fulguration, intracavitary radiation therapy and transanal electrocoagulation therapy (TEC). The selection among the various techniques for limited palliative or cura- tive surgery takes place according to the tumour size, the macroscopic appearance and the tumour site [2]. Major advantages of TEC as a local treatment include minimally invasive anaesthesia, less operative time than the open procedure, less pain and shorter hospital stay. Criteria and patient selection have been debatable in the literature for curative TEC. Proper patient selection is critical for the tech- nical success of this operation. Criteria may include tumours less than 3–4 cm in diameter, polypoid (exophitic) or plateau like in appearance. The diameter of the tumour should be less than 40% of the rectal circumference, with absence of palpa- ble perirectal nodes, and without evidence of invasion of the perirectal tissue [3]. However in patients over 70 years of age, as well as in those who carry an increased operative risk, TEC can play a role as a palliative treatment without the above mentioned criteria. Obviously, small tumour size, exophytic appearance, and absence of surrounding structures invasion can help to avoid complications. S. Delikoukos • D. Zacharoulis • C. Hatzitheofilou Electrocoagulation: an alternative palliative treatment for rectal cancer Abstract Background We present our experience with pal- liative transanal electrocoagulation therapy (TEC) for rectal cancer. Methods Eight patients with biopsy-proven localised low rectal adenocarcinoma were treated with pal- liative TEC. Inclusion criteria were: high risk patients with anal adenocarcinoma less than 3 cm in diameter, localised less than 7 cm from the anal verge, limited to the rectal wall. Under local anaesthesia all patients underwent TEC using the traditional cautery. Results No mortality and morbidity was found. Four patients required a second procedure and one patient had a third session . Two patients died within 2 years from distal metastasis. The remaining six patients are alive and free of local recurrence (follow-up 9 months to 4 years). Conclusions In poor surgical candidates, palliative TEC of rectal adenocarcinoma may have a role as an alter- native to radical surgical treatment. Key words Electrocoagulation • Rectal cancer Tech Coloproctol (2004) 8:S76–S78 DOI 10.1007/s10151-004-0118-9