LAR or Not

[mike1965]

Andrea,

I know what you are experiencing. I am going thru the same thing. But I have made up my mind to have surgery. I will find out tomorrow if my medical group approved the surgery. I had to go outside medical group since their surgeon would not do the surgery. I do not want the uncertainly of the wait and see approach. I do not want to second guess myself with should have could have. I want no regrets so I will do the surgery soon. I want to know that I did everything possible to battle this. In my case every doctor says surgery except the one surgeon. Each person is different and you have to do what you think is best for you. I wish you luck. I think traveling that sounds difficult.

[Andrea1976]

Mike,
For sure in your case I would have the surgery. I am suprised that the 1 surgeon is not recommending it. From my research your case is pretty clear to have surgery.

[Ken1378]

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)

I came across EMR in another post and am reading up on it. Thanks, Ill look into the ESD. I was surprised that something like EMR wasn't used during the colonoscopy.

Removing polyp: The GI Dr had a hard time getting the cutting loop around the 50mm polyp and took it out in pieces. With enough removed tried to get a "zip tie" around the base to cause what was left it to die off. I wasn't tight enough, so it was still there the next month. The ties actually got in the way when trying to get the cutting loop around the remains. The Polyp was removed down to the zip tie loops and refereed to the surgeon

[Nik Colon]

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)

I came across EMR in another post and am reading up on it. Thanks, Ill look into the ESD. I was surprised that something like EMR wasn't used during the colonoscopy.

Removing polyp: The GI Dr had a hard time getting the cutting loop around the 50mm polyp and took it out in pieces. With enough removed tried to get a "zip tie" around the base to cause what was left it to die off. I wasn't tight enough, so it was still there the next month. The ties actually got in the way when trying to get the cutting loop around the remains. The Polyp was removed down to the zip tie loops and refereed to the surgeon

Best wishes, hope all goes well

[Ken1378]

Back in Feb I came here to looking for some knowledge and understanding of what was being recommended. Doing a LAR and the amount of removal for one precancerous tumor seamed very excessive. Later it was explained that it's all about getting the 12 lymph nodes to declare it's clear. Not sure I still would accept this, but am happy to be avoiding the decision. After seeing the surgeon and posting on here, I got a second opinion from the Cancer Care Center. They start off with MRI's CT and the works, which looked normal. The surgeon#2 did a flex sigmascope which gave us the chance to discuss what I saw during both colonoscopies. Long story short, since I can't type and spell half this stuff, she recommends me to one of the top GI dr's to make a last attempt to remove the remaining base of the polyp, while scheduling a surgery just in case. Lifting and digging deep and removing with care to check the edges, a few staples to close things up, I was back to waiting for pathology. Results looked good, come back in 6 months. So, I did a 6 month colonoscopy last month, and no new polyps, scar site was clear, and biopsy taken from the site came back clear. Next stop, Colonoscopy in 2 years.

One thing I am glad for was not being sedated. Only the first colonoscopy did they insist on a small amount, but I was aware and remember most of it. Seeing what was going on and being aware of the degree of the polyp, made it easier to make the decision to have a surgery. I was just expecting a inch or two removal. The plan to do a LAR (10-12 inches) for one polyp is where I had issues. Also, only surgeon#1 took a look with a scope that I could not see what she saw. Surgeon#1 also thought the GI over estimated the depth, saying it was at 12cm, it was at 18 as the original GI stated. Thus I wanted a second opinion. Turns out the second surgeon, agreed that the safest was to do a LAR, but also looked closely at the polyp and didn't rush the surgery.

I wish everyone here the best. I realize how lucky I am at this moment with a clear biopsy after 6 months and no surgery. Most here have much more to deal with.

[MikeManess]

Andrea,

Who is your surgeon at UT Southwestern? My surgeon that did my resection was Dr. Polonco. He's also the one that will be removing my liver tumors (2) via wedge resection in mid-Dec. If it is Dr. Polonco, he's a very good surgeon. I trust his judgement, but only you can make the final decision.

[Andrea1976]

Yes, I go to Doc Polanco. I really like him and trust him. He always explains everything to me and is compassionate. Just a great Doc. He set me up with breast cancer surgeon because I have strong family history. Well, the breast cancer surgeon discovered stage 0 Melanoma on my breast. I am so mad since I have been going to dermatologist for over 5 years and she never question my mole. The breast surgeon just too one look at it and said it needs to come out. Just had the surgery and it was stage 0 before becoming invasive. I had the mole for over 10 years. Good luck with your surgery. You are in great hands. I have transferred all my doc to UT southwestern.