LAR or Not

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Andrea1976
Posts: 384
Joined: Sun Jan 03, 2016 10:32 am

LAR or Not

Postby Andrea1976 » Tue Feb 09, 2016 8:46 pm

Mike from the forum and I have been dealing with the same issue. Diagnosed stage 1 with grade 2 Pedunculated polyp. You can read from my pathology report. Stalk free of cancer no vessel involvement.

Here is my problem: surgical onco UT Southwestern, colorectal surgeon Dallas Presbyterian belive I don't need LAR.

Surgeon Baylor and oncologist Baylor recommends LAR.

Not sure what to do? Scheduled for LAR next Thursday.

Also my blood pressure has been increasing. I never had any issues until now. Yesterday it was 160/100. High for 39 year old. I am very stressed out. Busy at work, kids and dealing with maritual problems. My husband is checking out. I did get pills to lower my BP today. And will see a cardiologist.

Any suggestions?

Thanks!!!
Stage I
pedunculate polyp in descending colon
moderately diff adenocarcinoma 0.6 cm
Tumor confined to the head of the polyp
Stalk margin 2 cm negative for dysplasia and malignancy
Polyp removed during colonoscopy 1/15/16
No lymphovascular involved
No surgery

Buckeye
Posts: 109
Joined: Mon Jan 18, 2016 7:02 pm

Re: LAR or Not

Postby Buckeye » Tue Feb 09, 2016 10:41 pm

Andrea Only you can make this decision, but I will tell you what my colorectal surgeon told me. I had a 1cm flat lesion that was stage 1 . He could have just taken out the tumor locally by surgically removing it because it wasn't very deep. He said if he did that I would have a 30% chance of a recurrence that could show up anywhere and I could be dead before I was 55. He said if I had a LAR withTME I had less than a 10% chance for recurrence. I had just turned 47. So I decided for the more invasive surgery for my family and me because I wanted the best possible chance for a cure, and I am not a good gambler. Good luck, and best wishes for which ever decision you make. I will try to answer any further questions if I can.
Dx 10/20/15 stage 1 T1N0M0 1.3cmx1.1cmx1cm low grade ( well to moderately differentiated) Rectal cancer age 47
Loving Husband and father of two girls age 19 & 15 Sole income provider
CEA <0.5
CT, MRI and PET show no metastatic spread
LAR Laparoscopic TME 11/30/15 with Illo
Pathology clean no lymph node or vascular involvement. Confirmed Stage1
No chemo/rad cancer free now and forever.
Illo reversal 01/26/16

User avatar
chrisca
Posts: 242
Joined: Wed Dec 07, 2011 10:35 pm
Location: Portland, Oregon

Re: LAR or Not

Postby chrisca » Wed Feb 10, 2016 4:09 am

If you are an active person, consider local excision with watchful waiting (the Habr-Gama protocol). LAR is no picnic and if you have a bad outcome with LAR syndrome, life will never be the same. If you do opt for LAR, get a surgeon who can do a "low tie" of the inferior mesenteric artery, which will reduce the odds of LAR syndrome developing.
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 10 years

ozziej
Posts: 239
Joined: Thu May 21, 2015 8:35 pm

Re: LAR or Not

Postby ozziej » Wed Feb 10, 2016 5:57 am

Hi Andrea,
This is a really tough decision. I had to make a similar decision a year ago. Unfortunately, neither choice gives you 100% certainty. The local excision/watch & wait route risks missing possible lymph node involvement, but is no more traumatic than a colonoscopy. The LAR/ULAR path gives more certainty re lymph node involvement but is definitely no walk in the park. Major surgery, possible temporary ileostomy and reversal, and the very real chance of ongoing LAR syndrome. In hindsight, I would say that, at your age and with your work and family commitments, if you can tolerate a degree of uncertainty and are prepared to adhere to a stringent surveillance schedule then local excision/watch & wait route would be the way to go. Mind you, this is direct conflict with my surgeon's recommendation: age 45 and less, definitely have the LAR; age 75 and over, definitely watch & wait; in between, your choice (I was 56). Then again, he isn't the one who has to cope with the surgery, temporary stoma, reversal, and ongoing bowel issues, whilst simultaneously holding down a job, parenting, and keeping a relationship together. On the other hand, I had the ULAR so have the comfort of knowing that I had no lymph node involvement. The relief this brings can't be underestimated.
Only you can decide what is right for you.
Best wishes
Jan
PS. I was really stressed too, to the point of having panic attacks, prior to making my decision. I found talking to a counsellor, and taking a low dose anti-depressant really helped.
F 56 dx 11/14 Stage 1 RC (post EMR)
No neo-adjuvant or adjuvant chemo/RD
3/15 ULAR (open) temp loop ileo
5/15 ileo reversal
NED and hoping to stay that way!! : )

Andrea1976
Posts: 384
Joined: Sun Jan 03, 2016 10:32 am

Re: LAR or Not

Postby Andrea1976 » Wed Feb 10, 2016 8:14 am

Thank you! The polyp was already removed during colonoscopy and the 2 cm stalk was free of cancer. My Baylor surgeon and oncologist still recommends LAR. 3 other surgeons including Southwestern surgical onco recommend to wait. I am being tested for Lynch and should know in few weeks.

I think I will have the surgery and hope for the best. I am in great shape and very active.

The surgical onco at Southwestern is willing to see me one more time tomorrow to discuss my situation. He was extremely knowledgable and I felt in good hands with him.

I was told can't drive for 2 weeks. But can I early? How bad is the recovery. My husband is out of town so I will have to ask friends to help or Huber, taxi etc..,
Stage I
pedunculate polyp in descending colon
moderately diff adenocarcinoma 0.6 cm
Tumor confined to the head of the polyp
Stalk margin 2 cm negative for dysplasia and malignancy
Polyp removed during colonoscopy 1/15/16
No lymphovascular involved
No surgery

Nik Colon

Re: LAR or Not

Postby Nik Colon » Wed Feb 10, 2016 5:08 pm

I personally would not do it since it was only in the head and they got clear margins, but that's just me.

David from Canada
Posts: 14
Joined: Mon Nov 02, 2015 5:54 pm

Re: LAR or Not

Postby David from Canada » Wed Feb 10, 2016 5:44 pm

Andrea,
I'm just recovering from LAR surgery and entering week 3 post surgery. I'm thinking I'll be able to drive next week but still need to check with insurance if they have other rules. I spent 7 days in the hospital and tapered off the narcotics for pain the next week. Currently I'm not taking anything for pain and feel comfortable shoulder checking by Monday.

Good luck with your decision, I've been pretty lucky so far and been given a choice of chemistry for the next round, going to choose the harder one to do everything I can to make sure this doesn't come back.

All the best

David
30 yrs old
RC Dx Sept 11, 2015
EUS Sept stage 3b T3N1, 7cm from verge
CT scan Sept no mets
Started Xeloda and rad Oct 20 (28 rads)
Last Rad, Chemo Dec 1 -worked full time throughout, from home last 2 weeks
CT and MRI - complete clinical response
LAR and temp ileo Jan 25 -NED
Complete pathological response
4mo Folfox
Ileo reversal Sept 2
1 year Cancer free Jan 25 2017

User avatar
BeansMama
Posts: 959
Joined: Thu Jan 28, 2016 1:38 am
Location: North Carolina

Re: LAR or Not

Postby BeansMama » Wed Feb 10, 2016 6:45 pm

I can't say what I would do in your position, I can say there is a possibility the surgery can go very wrong. I am proof of that. I had my first surgery on 11/18/15 and I still cannot drive. The first ostomy site malfunctioned and poured stool into my incision. I had a wound vac for almost 3 months, I no longer have to wear the vac but my wounds from that surgery are still healing and I have a way to go.

If you do it make sure the surgeon is good, and really think about it. If you won't have much help available you may want to wait until you do.
41 yrs old
Tumor found 9/2015
Surgery 1 - 11/2015 LAR and colostomy
Surgery 2 - 11/2015 wound vac
Surgery 3 - 12/2015 revise resection, move colostomy
Mets to liver - tumor inoperable - one add'l met destroyed
Stage IVa (T3 N2a M1a)
Primary tumor 9 cm x 7.5 cm x 2 cm
Beginning Folfox 1/2016 - Failed
Beginning Folfiri and vectibix 8/2016 — Failed
Beginning Folfirinox + Avastin 11/2016 - Failed
Beginning Keytruda 1/2017
CEA drop from 345 to 7.3 after starting immunotherapy
Lynch positive 3/2016

Andrea1976
Posts: 384
Joined: Sun Jan 03, 2016 10:32 am

Re: LAR or Not

Postby Andrea1976 » Wed Feb 10, 2016 7:13 pm

Sorry to hear:-( hope you feel better soon. I know that either way is no winning...
Stage I
pedunculate polyp in descending colon
moderately diff adenocarcinoma 0.6 cm
Tumor confined to the head of the polyp
Stalk margin 2 cm negative for dysplasia and malignancy
Polyp removed during colonoscopy 1/15/16
No lymphovascular involved
No surgery

Nik Colon

Re: LAR or Not

Postby Nik Colon » Wed Feb 10, 2016 7:35 pm

I wanted to add. Mike had a flat polyp where yours was pedunculated and had clear margins, I know he mentioned because of it being flat, that was another concern (assuming it's the same Mike).

Andrea1976
Posts: 384
Joined: Sun Jan 03, 2016 10:32 am

Re: LAR or Not

Postby Andrea1976 » Wed Feb 10, 2016 8:11 pm

Hi Nik,
You are correct. Just that 3-6% chance of lymph node involvement is scary.
The surgical oncologist at Soutwestern is willing to see me one more time during his off patient hours. I really appreciate it.
Stage I
pedunculate polyp in descending colon
moderately diff adenocarcinoma 0.6 cm
Tumor confined to the head of the polyp
Stalk margin 2 cm negative for dysplasia and malignancy
Polyp removed during colonoscopy 1/15/16
No lymphovascular involved
No surgery

Nik Colon

Re: LAR or Not

Postby Nik Colon » Wed Feb 10, 2016 8:13 pm

Andrea1976 wrote:Hi Nik,
You are correct. Just that 3-6% chance of lymph node involvement is scary.
The surgical oncologist at Soutwestern is willing to see me one more time during his off patient hours. I really appreciate it.

Just wanted to make sure you were aware. Best wishes

Andrea1976
Posts: 384
Joined: Sun Jan 03, 2016 10:32 am

Re: LAR or Not

Postby Andrea1976 » Wed Feb 10, 2016 8:20 pm

Thank you Nik!!!
Stage I
pedunculate polyp in descending colon
moderately diff adenocarcinoma 0.6 cm
Tumor confined to the head of the polyp
Stalk margin 2 cm negative for dysplasia and malignancy
Polyp removed during colonoscopy 1/15/16
No lymphovascular involved
No surgery

Buckeye
Posts: 109
Joined: Mon Jan 18, 2016 7:02 pm

Re: LAR or Not

Postby Buckeye » Wed Feb 10, 2016 9:22 pm

Andrea is the surgery laparoscopic or open. There is a huge difference in recovery time. I had laparoscopic and was up and about in two weeks. I was driving as soon as I was off the narcartics.
Dx 10/20/15 stage 1 T1N0M0 1.3cmx1.1cmx1cm low grade ( well to moderately differentiated) Rectal cancer age 47
Loving Husband and father of two girls age 19 & 15 Sole income provider
CEA <0.5
CT, MRI and PET show no metastatic spread
LAR Laparoscopic TME 11/30/15 with Illo
Pathology clean no lymph node or vascular involvement. Confirmed Stage1
No chemo/rad cancer free now and forever.
Illo reversal 01/26/16

Andrea1976
Posts: 384
Joined: Sun Jan 03, 2016 10:32 am

Re: LAR or Not

Postby Andrea1976 » Wed Feb 10, 2016 10:07 pm

Laparoscopic. Thank you! Happy to hear that you recovered soon.
Stage I
pedunculate polyp in descending colon
moderately diff adenocarcinoma 0.6 cm
Tumor confined to the head of the polyp
Stalk margin 2 cm negative for dysplasia and malignancy
Polyp removed during colonoscopy 1/15/16
No lymphovascular involved
No surgery


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