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.
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!! : )