Sorry in advance for the long post! I have rectal resection surgery scheduled for 23 March. My surgeon gave me some good and bad news about the operation yesterday. The good news is that the the CT and MRI came back looking mostly good and I am "probably" at stage 1. The bad news is that they showed that the tumour was very low, 2.5cm above the dentate line. My surgeon laid out 3 options - watch and wait for 3 months, ULAR or APR. He said I have a 90% chance of survival if I watch and wait or 95% if I go for surgery so I am really leaning towards surgery. The ULAR will be difficult due to the location and it will not be possible to staple so he would perform the surgery with the assistance of another surgeon who specialises in hand stitching. There is a higher risk of complications than an APR (the surgeon was mostly worried about anastomotic leaks) or of hitting a nerve or blood vessel that could cause sexual dysfunction or incontinence. It would also require 2 operations rather than one. On the other hand, I am quite an active 33 year old - I regularly run marathons, cycle, swim, scuba dive, go to the beach, etc so I'm worried that an APR with a permanent bag will have a bigger impact on my life, though from what I've read the bags are very good these days and not very restrictive. My surgeon said he spoke to 8 other colorectal surgeons and they were all equally divided on which option to go with. I was really expecting it would more clear cut but my situation just seems so borderline.
Has anyone gone through a similar experience? What guided your decision? And what was the result? Are there any other questions I should be asking or other aspects I should be considering? I am trying to write down all the downsides of each choice and here is what I have come up with:
Watch and wait:
- Lower survival rate
- I will not know the exact stage
ULAR:
- Risk of anastomotic leak
- Risk of sexual dysfunction
- Risk of incontinence
- Higher risk of local recurrence as part of the rectum is left behind?
- Two operations instead of one
APR:
- Lifestyle change
Any info from anyone who has been in this situation would be really, really appreciated as I feel like I am changing my mind every time I think about it!