Useful article on LAR

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Useful article on LAR

Postby chrisca » Sat Feb 21, 2015 10:05 pm

This paper is free and worth reading before you have LAR surgery, or after it. It is technical, but readable.

Functional results after treatment for rectal cancer
J COLOPROCTOL. 2014; 34(1): 55 – 61 ... -00055.pdf

I wish I had read it before my surgery. On page 58 is the key thing to discuss with your doctor before surgery:

Recently, a study showed that careful preservation of the
colonic and pelvic nerves can result in less fragmentation of
stools. In high ligation of the inferior mesenteric artery and
dissection of the lymph nodes close to the aorta, the extrinsic
autonomic sympathetic nerves to the rectum and left side of
the colon are resected, causing a sympathetically denervated
colonic segment used for creation of the neorectum. This
has been suggested to be a major cause of stool fragmentation,
due to the missing negative feedback of the defecation
reflex, causing an urge to defecate even when only small
amounts of stools are present in the neorectum. Therefore,
it has been suggested that resection with preservation of the
left colonic artery might preserve autonomic function without
compromising oncological outcome.
Male, false negative colonoscopy age 48
DX: 12/2010 rectal cancer age 51
Stage T3N0M0 2 cm from anal verge
neoadjuvant rad/chemo Xeloda
Rectal resection (open surgery) straight anastomosis
Xeloda round 2
ileostomy reversal 11/2011
Successful adhesion X-lap 8/2013
Ongoing LAR syndrome but NED 7 years

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