I'm wondering what advice people have been giving regarding surgical options for a low rectal tumor that is descending into the anal canal. My surgeon here in Portland has recommended that a sphincter-saving LAR is possible, depending on how much thee tumor shrinks during surgery (i.e., it is no longer in the anal canal). Otherwise, if the tumor does not respond, he will perform an APR and I will wind up with a permanent colostomy bag. Given the sensitive location of the tumor, I went to the Mayo Clinic in Rochester for a second opinion, and they were pretty firm in their recommendation that I get an APR. They wouldn't even offer an LAR. Their view was that wherever the tumor has been, that tissue needs to go to maximize the chances of avoiding locally recurrent cancer. I felt that the Mayo recommendation made sense, although it sounded a bit conservative. Granted, they see all of the LAR procedures where sphincter saving surgery was performed and some tissue where a tumor had been had been left behind, and the cancer had come back, and all the nightmares that can bring. So, given that they see these tough cases, their viewpoint makes sense.
My Portland surgeon cited a study done out East involving several hundred patients who underwent coloanal resection as part of a sphincter saving surgery. He said the local recurrence rate was about 4-5% and that 90-95% were happy with their choice not to have an APR. He said roughly half had pretty good or normal stool control. I didn't get the author of the study, but plan to ask him.
Obviously, my number one goal is to eradicate all cancer cells from my body. If that means I have to wind up with a bag, so be it. I won't be happy with it, but I'll live it up. BUT, if there's a chance the sphincter can be saved, and that it doesn't jeopardize my health, I would want to give that a shot. Like anyone facing this, I'm concerned with quality of life issues. Both the LAR and APR have associated QoL issues. With an LAR you may have to deal with a leaky bottom. With an APR, you have to deal with a colostomy bag. My diagnosis is fairly recent (less than 1 mo ago), so I still haven't come around to the idea of living with a bag (although I've come quite a ways).
So, I'm looking for what other people have told regarding the surgical removal of tissue where a tumor HAD been as a result of pre-op chemo/radiation. Have they been told that it should be taken out (the Mayo line), or that it can be left in (my Portland surgeon's recommendation).
Any help would be greatly appreciated.
Stage III rectal CA
Starting chemo/radiation 2/22/10
Last edited by wombat
on Wed Feb 17, 2010 2:24 pm, edited 1 time in total.