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Status of fulguration and cryosurgery in the management of colonic and rectal cancer and polyps

If a cancer of the upper or lower colon can be treated by segmental resection or anterior resection with re‐establishment of intestinal continuity, then conservative treatment by fulguration or cryosurgery has little place in the management of the lesion. On the other hand, if combined abdominal resection is required for the treatment of tumor, because of its location in the lower rectum or other anatomical or technical problems, and a permanent colostomy is necessary, then local treatment must be considered. It is unfortunate to have established a permanent colonic stoma if the radical operation has not contributed to the future well‐being of the patient. If lesions are carefully selected for fulguration when a colostomy would otherwise be required, the survival rate compares favorably or is better than when radical surgery is used. The theoretical advantage of radical surgery is offset by the mortality of the procedure. For recurrence of cancer after conservative treatment, combined abdominal resection can almost always be done. Selection of cases for local treatment is based on several factors: lesion is well differentiated (Broders' Grade 1 or 2); lesion is localized (Dukes “A or early Dukes” B); lesion is small and not circumferential; lesion is not on the anterior wall of the rectum in female patients; and increased risk of surgery in patients with complicating medical conditions.