LAR or Not

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Cowgirl918
Posts: 319
Joined: Sun Jan 17, 2016 12:55 am
Location: Indiana

Re: LAR or Not

Postby Cowgirl918 » Thu Feb 11, 2016 12:27 am

This is such a difficult and personal choice. I think you must listen to everyone including your doctors and then make the choice that YOU can live with. There is not a right or wrong choice here. Each carries different but significant burdens.
I cancelled my hemicolectomy and opted for EMR even though my surgeon advised a very aggressive surgery, now. I ride horses and the thought of being inactive was not acceptable to me. However, if the tumor is malignant I will have an even tougher decision to make. It is large and wide at the base. I am older with no responsibilities. That makes a hug difference. Listen to your intuition and good luck.
HX Colon Polyps Villious and Tubillovillous
12/29/15 Colonoscopy/Endoscopy - Ascending Colon Mass- Hemicolectomy Scheduled
1/17/2016 Right Hemicolectomy Cancelled
1/25/2016 CT No evidence of other disease
2/12/2016 EMR-ascending colon mass 80% removed
5/29/2016 Compressed lumbar spinal fracture (riding accident)
8/12/2016 EMR #2 ascending colon mass curative
8/13/16 NED
10/18/16 Autoimmune Diseases confirmed

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

Re: LAR or Not

Postby Andrea1976 » Thu Feb 11, 2016 3:04 pm

What a hard decision.

Pedunculated polyp (looks like a mushroom) descending colon
Invasive, moderately differentiated adenocarcinoma arising in a tubulowillous adenoma with high grade dyspasia.
No angiolymphatic space invasion identified
Stalk margin negative for dysplasia and malignancy
tumor sis confined to the head of the polyp. The stalk margin shows no adenomatious change or carcinoma. The case was reviewed by another person the head of pathology dep.

1 surgeon recommends surgery and believe I have 3-6% chance of lymph node involvement. Oncologist who works with this surgeon also recommends surgery.
2. surgeon atDallas Presbyterian Hospital with 40 years of experience does not believe I should have the surgery. He has requested his pathology dep to review my pathology. He has reviewed my case with other surgeons and will call me today.
3. Surgical Oncologist at only large cancer center in Dallas Southwestern does not believe I should have the surgery. He has consulted my case with the head of the department and other surgeons and believe I should be observed. He says the risk of LAR are higher than the chance my lymph nodes are involved. He is recommending MRI in 3 months to check the abdomen and lymph nodes. He has requested his pathology dep to review my pathology.

I know it's crazy that I have 3 different pathologist to review but I guess mistakes could happen...

What a decision... :cry:
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

CM35
Posts: 265
Joined: Tue Dec 03, 2013 1:16 pm

Re: LAR or Not

Postby CM35 » Thu Feb 11, 2016 3:45 pm

I know this is a very difficult decison, and definitely personal. No one person can tell you what to do...however, I have had TWO LAR procedures done, both open, during major metastectomy operations. It is definitely major surgery, but I will say absolutely doable! My first LAR was in conjunction with a liver resection and also had my ovaries out. I was reconnected in surgery, and did not require an ileostomy. My bowels were fully functional within about 5 days, and was allowed to resume my normal diet as I felt comfortable, and truly had little to no digestive issues. My bowel patterns did change, more frequent bowel movements, but it didn't affect quality of life in any remarkable way. My second LAR, I had a temporary ileostomy placed as it was lower in the rectum. It was done during HIPEC surgery. The ileostomy was reversed 9 weeks and 1 day later. Again, I didn't have any remarkable bowel issues after i healed up. I know not everyone experiences these things the same way, but I did want to offer you a good outcome, in a real person, if you are seriously considering the surgery route!

Best wishes as you make your decisions!
stg IV 4/2013 @34 - liver, ovary/peritoneum
Lots of chemo, surgery and good luck - still doing well 03/2016...

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

Re: LAR or Not

Postby Andrea1976 » Thu Feb 11, 2016 4:51 pm

Thank you!!! I really appreciate your experience. And wish you the best:-)
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

Ken1378
Posts: 5
Joined: Wed Feb 10, 2016 3:33 pm

Re: LAR or Not

Postby Ken1378 » Mon Feb 15, 2016 12:47 pm

New here looking for the same info. During colonoscopies, had a 50mm pedunculated polyp removed; precancerous, but no cancer detected. GI Dr not sure of fully removing all of polyp and sent me to Surgeon who is suggesting a LAR. Was OK with cutting out a small are where the polyp was, but surprised by the amount they recommend taking out.

Will post my own thread, but am interested in your decision.
age 50 married male
12/2015 Colonoscopy partial removal 50mm pedunculated polyp in sigmond colon
1/16 second colonoscopy to remove remains of 50mm. Fragments removed showed precancerous, but no cancer detected. Refereed to surgeon
2/16 Surgeon suggest LAR
3/16 Second Opinion - Surgeon #2 send to GI
2ed GI removed remains on 50mm polyp, edges (?) ok
10/16 Colonoscopy, biopsy at scar site = clear.
(10/18 go back for colonoscopy)

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

Re: LAR or Not

Postby Andrea1976 » Tue Feb 16, 2016 6:44 pm

You are lucky that your is NOT cancer. Mine was already malignant. Scheduled LAR for 2/29. Surgeon said I have very low chance of having a bag - since my polyp was higher in descending colon. Also LAR syndrome is not an issue for me according to him.

Working with 4 different colorectal surgeons. The 4th one really explained to me that in my case it's my decision: What risk am I willing to take. It seems that having LAR will eliminate some of the risk of lymph node involvement which in my case is about 5%.

Update on my genetic testing for Lynch. Insurance will cover it and my payment will not be more than $375. That sounds good. It's in the lab and should know about 2 weeks.
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

User avatar
Cowgirl918
Posts: 319
Joined: Sun Jan 17, 2016 12:55 am
Location: Indiana

Re: LAR or Not

Postby Cowgirl918 » Tue Feb 16, 2016 10:52 pm

I know you are relieved to have the decision made. Keep us posted before and after. I am thinking about you and hope that now you will be able to relax a little. You have much going on but I can tell that you are strong. Take Care
HX Colon Polyps Villious and Tubillovillous
12/29/15 Colonoscopy/Endoscopy - Ascending Colon Mass- Hemicolectomy Scheduled
1/17/2016 Right Hemicolectomy Cancelled
1/25/2016 CT No evidence of other disease
2/12/2016 EMR-ascending colon mass 80% removed
5/29/2016 Compressed lumbar spinal fracture (riding accident)
8/12/2016 EMR #2 ascending colon mass curative
8/13/16 NED
10/18/16 Autoimmune Diseases confirmed

Ken1378
Posts: 5
Joined: Wed Feb 10, 2016 3:33 pm

Re: LAR or Not

Postby Ken1378 » Wed Feb 17, 2016 8:30 pm

I do feel lucky I think. It seams the surgery treatment is the same regardless. Was really expecting just a small area removed, but don't know if that even an option. Right now I reading and finding out all that I can.

I wish you well on your surgery and speedy recovery
age 50 married male
12/2015 Colonoscopy partial removal 50mm pedunculated polyp in sigmond colon
1/16 second colonoscopy to remove remains of 50mm. Fragments removed showed precancerous, but no cancer detected. Refereed to surgeon
2/16 Surgeon suggest LAR
3/16 Second Opinion - Surgeon #2 send to GI
2ed GI removed remains on 50mm polyp, edges (?) ok
10/16 Colonoscopy, biopsy at scar site = clear.
(10/18 go back for colonoscopy)

Nik Colon

Re: LAR or Not

Postby Nik Colon » Wed Feb 17, 2016 8:56 pm

Ken1378 wrote:I do feel lucky I think. It seams the surgery treatment is the same regardless. Was really expecting just a small area removed, but don't know if that even an option. Right now I reading and finding out all that I can.

I wish you well on your surgery and speedy recovery

Why would they want to do an LAR when no cancer was detected? I guess I just don't understand why they would risk surgery. Any surgery comes with its own risks itself.

Is it because of the size?

1/16 second colonoscopy to remove remains of 50mm. Fragments removed showed precancerous, but no cancer detected. Refereed to surgeon
2/16 Surgeon suggest LAR
Last edited by Nik Colon on Wed Feb 17, 2016 10:10 pm, edited 1 time in total.

mike1965
Posts: 118
Joined: Mon Jan 25, 2016 11:07 pm

Re: LAR or Not

Postby mike1965 » Wed Feb 17, 2016 9:13 pm

Good luck Andrea on your surgery. I am also trying to get surgery scheduled. It was a tough decision but I have to know if there is still cancer in me. Lets us know how it goes.
Colonoscopy 09/06/15 Doctor removed polyp
DX - Rectal cancer 09/10/2015 T1M0N0
Surgeon recommended wait and see approach 09/2015
Tumor board recommended LARs Surgery 10/2015
Oncologist and PCP recommended LARs Surgery 11/2015
Seeking 2nd opinion from another Surgeon 01/2016
Having Sigmoidscopy on 02/01/16.
Figured out treatment 02/2016
LARS Surgery 03/2016
Stage 3A T1 N1C M0
Chemo Folfox to begin 04/18/16

mike1965
Posts: 118
Joined: Mon Jan 25, 2016 11:07 pm

Re: LAR or Not

Postby mike1965 » Wed Feb 17, 2016 9:16 pm

Ken 1378. Why are they suggesting LAR's if no cancer was found. Seems like an aggressive option. I have cancer and my main surgeon refused to do the surgery. I wish you good luck in your decision.
Colonoscopy 09/06/15 Doctor removed polyp
DX - Rectal cancer 09/10/2015 T1M0N0
Surgeon recommended wait and see approach 09/2015
Tumor board recommended LARs Surgery 10/2015
Oncologist and PCP recommended LARs Surgery 11/2015
Seeking 2nd opinion from another Surgeon 01/2016
Having Sigmoidscopy on 02/01/16.
Figured out treatment 02/2016
LARS Surgery 03/2016
Stage 3A T1 N1C M0
Chemo Folfox to begin 04/18/16

Ken1378
Posts: 5
Joined: Wed Feb 10, 2016 3:33 pm

Re: LAR or Not

Postby Ken1378 » Wed Feb 17, 2016 10:52 pm

I didn't want to Hi-jack Andrea's thread, but to LAR or Not is the issue. Not sure if there are other options.

Dr could not completely remove it on first colonoscopy, took it out in pieces. Tried to tie it off to get it to "die off" ties and remains were still there a month later during second colonoscopy. The second time in, they removed more, but ended up leaving the ties in there and the results were:

Results:
Fragments of polyp removed at the prior partial polypectomy site again showed precancerous cells, but no cancer was detected.

Recommendations:
Please see Dr. for surgical consultation as we discussed, because of the inability to safely and completely remove your large sigmoid colon polyp. This will require a surgical procedure to remove and prevent cancer from developing at this site.

I visioned removing a couple of inches to prevent future problem. Surgeon took a look and thought it was at 12cm were colonoscopy Dr said 18-20 cm in. Surgeon describe the LAR and how everything got rerouted and such. SO after it all sinking in I'm looking for the info needed to ask the right questions or agree with the recommendations.
age 50 married male
12/2015 Colonoscopy partial removal 50mm pedunculated polyp in sigmond colon
1/16 second colonoscopy to remove remains of 50mm. Fragments removed showed precancerous, but no cancer detected. Refereed to surgeon
2/16 Surgeon suggest LAR
3/16 Second Opinion - Surgeon #2 send to GI
2ed GI removed remains on 50mm polyp, edges (?) ok
10/16 Colonoscopy, biopsy at scar site = clear.
(10/18 go back for colonoscopy)

Nik Colon

Re: LAR or Not

Postby Nik Colon » Thu Feb 18, 2016 1:08 am

Ken1378 wrote:I didn't want to Hi-jack Andrea's thread, but to LAR or Not is the issue. Not sure if there are other options.

Dr could not completely remove it on first colonoscopy, took it out in pieces. Tried to tie it off to get it to "die off" ties and remains were still there a month later during second colonoscopy. The second time in, they removed more, but ended up leaving the ties in there and the results were:

Results:
Fragments of polyp removed at the prior partial polypectomy site again showed precancerous cells, but no cancer was detected.

Recommendations:
Please see Dr. for surgical consultation as we discussed, because of the inability to safely and completely remove your large sigmoid colon polyp. This will require a surgical procedure to remove and prevent cancer from developing at this site.

I visioned removing a couple of inches to prevent future problem. Surgeon took a look and thought it was at 12cm were colonoscopy Dr said 18-20 cm in. Surgeon describe the LAR and how everything got rerouted and such. SO after it all sinking in I'm looking for the info needed to ask the right questions or agree with the recommendations.

You could ask your doc about this...
http://www.sciencedirect.com/science/ar ... 711370150X

Also, the post I made about EMR and ESD
viewtopic.php?f=1&t=53724

I'm not sure if that info will help, butt....

(Also, I'm not sure how they removed your polyp, just seen it was done in sections during 2 colonoscopies)

drw
Posts: 51
Joined: Sun Mar 30, 2014 4:43 am

Re: LAR or Not

Postby drw » Thu Feb 18, 2016 7:19 am

I had a flat polyp that everyone thought was stage 1. I had a tae and was told to follow up with the oncologist. After a ct and pet scan showed 2 lymph nodes that slightly concerned my oncologist, I was sent back to my surgeon. The surgeon and oncologist thought that a lar was over treating but they said that surgery was the only way to check lymph nodes. I asked the same question on this board and I got great advice, as always. I was completely freaked out that they were going to remove my rectum because of a slight chance of involvement. I opted for the surgery, thankfully. I was stage 3 and I started treatment 3 months after surgery. Good luck with your decision.
4/14 dx rectal cancer at 45 yoa
4/14 transanal excision
6/14 lar - 2 positive lymph nodes stage 3
8/14 started radiation and xeloda
1/15 completed chemo
2/15 Ned :)
3/15 reversal

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

Re: LAR or Not

Postby Andrea1976 » Thu Feb 18, 2016 5:36 pm

Hi,

Thank you all for comments. Yes, that's tge problem with Cancer - you never know. I have had 3 major pathologist / hospitals review my polyp. I had a 5 cm Pedunculated polyp - looks like mushroom with stalk completely removed during colonoscopy. My GI took extra margin / deeper. He said that I was cured and done in his opinion. All agree Cancer is in the head only with stalk being completely clear of cancer, lymphatic invasion etc...BUT still in a case like this there is a chance of lymph node invasion some studies say less than 1% and some 3-6%.
Cancer center recommends to wait along with other colorectal surgeon. They want to monitor me with MRIs, blood tests CEA 0.3 eyc. Board at his hospital said to wait and observe. I will see him on Monday so will ask one more time.
2 Baylor hospital colorectal surgeons and Baylor oncologist is supporting LAR because of my age. I also know that even if there is no cancer in my lymph nodes. There is a minimum chance that cancer could spread by blood and show up 10 years later??? How do you ever find piece??? LAR scheduled for 2/29. I am post to fly to East Coast on 3/18. Trying to get the surgery sooner. Is it possible to take 3 hour flight 18 days after LAR?
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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