LAR surgery - what to expect

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Swirdfish
Posts: 290
Joined: Sun Jun 19, 2016 3:57 am

LAR surgery - what to expect

Postby Swirdfish » Fri Aug 19, 2016 6:52 pm

Hi All,

So 3 more chemoradiation treatments and then my 6 week break. I meet my surgeon on Tuesday and he will more then likely give me a surgery date.

I've never in my life had any major surgery or in fact never been to hospital before all this.

I know a lot of members here have had LAR surgery or ultra low surgery, and may I ask what should I expect. How easy did you find it? Is it painful? Is it quick?

I know a lot of people say to walk the halls which I plan to do, but I'm more interested in the procedure itself and its effects afterwards.

I sort of panic when they wheel me into theatre and I'm unsure of what to expect?? Will I wake up.

It sounds like a big surgery to tunnel down into the pelvis area. My surgeon already said open surgery, but why not laparoscopic? I heard it's just as effective.

Does chemoradiation affect your pathological staging? And if so should I get treatment on my clinical staging?

Thanks
06/2016 Went in for colonoscopy came out with a tumor. Age 35
12cm from verge at junction. Rectal cancer.
Clinical stage T3 NO MO
Temp illestomy
Completed 5FU and Radiation
LAR surgery planned 13 Oct 2016
Completed ULAR surgery 11-10-2016.
0/22 nodes
pT3 N0 M0 R1
Stage 2A

Pathology reviewed and changed
ypT3 N0 M0 R0

Started folfox 21-11-2016
5-4-17 NED
Reversal 12-4-17

DarknessEmbraced
Posts: 3440
Joined: Sat Nov 01, 2014 4:54 pm
Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: LAR surgery - what to expect

Postby DarknessEmbraced » Fri Aug 19, 2016 7:22 pm

I had an open LAR surgery for colon cancer November 20th, 2014. I had an epidural put in the OR before I was put under. The epidural was painful to get in. I think the surgery took a couple of hours but I'm not sure. I don't even remember the recovery room or being wheeled up to my room. I had a urinary catheter in when I woke up. I was really out of it the first day. I was in the hospital until November 26th. I had problems with the urinary catheter getting kinked. When they took it out the first time I had blood clots in my bladder and couldn't pee so they had to put it back in for a couple of days. The epidural kept the pain bearable but they took it out after a couple of days. I wasn't prepared for the pain when the epidural wore off completely but they kept my pain under control. I was really nauseous for the first few days after my surgery but I was on a liquid diet anyway. They gave me anti nausea medication that helped. It took a few days for my bowels to wake up. Walking did help with that. I found it painful to get in and out of bed. When I coughed or sneezed I hugged a pillow. I had 23 staples holding my incision closed. At first there was a dressing over my incision but they took it off. After I went home I believe I had the staples in for a couple of weeks and then had them replaced with steri strips. I found it hard to bend so my boyfriend put everything up where I could reach it without bending. Showering was very tiring. I didn't have a lot of energy and would tire out easily. My bowel movements were usually many small bowel movements a day, diarrhea or constipation. It varied a lot and still does. I would sometimes have diarrhea accidents and was put on an anti-spasmodic(Dicetel) which helped with spasms. For a while I would get really sharp knife like pains on the right side of my abdomen when I would have bowel movements but they went away. I started having to avoid a lot of gas causing foods such as broccoli, cauliflower, cabbage, beans, etc.. I still avoid those foods, most raw veggies except those on a six inch sub, popcorn, peanuts, seeds. I had a sigmoidoscopy after my surgery later on to stretch the area where my colon was reattached. I had ischemic colitis(lack of blood flow to the colon) in January and was hospitalized for a week but it healed. I've still been having lots of pain, bloating, cramping and varied bowel movements. It took me many months to get my stamina and energy back. Everyone is different. I hope your surgery and recovery go well!*hugs* I forgot to mention that while I was in the hospital every night a nurse would do a blood thinner injection into my abdomen.
Last edited by DarknessEmbraced on Sun Aug 21, 2016 11:04 am, edited 1 time in total.
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17
NED 12/21/18
Clear colonoscopy 09/23/19
Clear 5 year scans 11/21/19- Considered cured! :)

Swirdfish
Posts: 290
Joined: Sun Jun 19, 2016 3:57 am

Re: LAR surgery - what to expect

Postby Swirdfish » Fri Aug 19, 2016 7:37 pm

Thanks darkness..

Doesn't sound like a lot of fun, hopefully mine goes well.

Recovery time after surgery where you would think you are well enough for full time work? I'm guessing a good month or two?
06/2016 Went in for colonoscopy came out with a tumor. Age 35
12cm from verge at junction. Rectal cancer.
Clinical stage T3 NO MO
Temp illestomy
Completed 5FU and Radiation
LAR surgery planned 13 Oct 2016
Completed ULAR surgery 11-10-2016.
0/22 nodes
pT3 N0 M0 R1
Stage 2A

Pathology reviewed and changed
ypT3 N0 M0 R0

Started folfox 21-11-2016
5-4-17 NED
Reversal 12-4-17

DarknessEmbraced
Posts: 3440
Joined: Sat Nov 01, 2014 4:54 pm
Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: LAR surgery - what to expect

Postby DarknessEmbraced » Sat Aug 20, 2016 12:02 pm

I'm not working so I'm not sure how to answer this question. It took me a few months to get back my energy level where I wouldn't have to rest a lot while walking around the mall or going down the three flights of stairs from my apartment. I think it took me about 4 or 5 months to get my energy back completely. It could have been a little less. Everyone is different though and it would depend on what type of job you have. Others may be able to answer your question.
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17
NED 12/21/18
Clear colonoscopy 09/23/19
Clear 5 year scans 11/21/19- Considered cured! :)

AnnClare
Posts: 241
Joined: Wed Sep 09, 2015 3:31 pm

Re: LAR surgery - what to expect

Postby AnnClare » Sat Aug 20, 2016 1:08 pm

Not sure how helpful I can be since my surgery was done robotically with numerous small (relatively speaking) incisions on my abdomen. They said I'd be released anywhere from 2 - 5 days post-op. Because I like to think of myself as hearty and a quick healer, I was sure I'd be released after 2 days. Nope - needed the whole five. The most painful thing for me was the bloating from the air they puff into you during surgery. Walking DEFINITELY helps alleviate this pain and helps to get the intestines moving/functioning. (Also, I have a temporary ileostomy, so again my experience is different from what yours will be.)

I agree with Darkness about holding a pillow to your abdomen if you cough or sneeze. The first time I sneezed post-op it HURT like HELL and I was sure I'd busted sutures (I didn't. Just felt like it!) My lower abdomen was puffy for about 1 1/2 weeks post-op, then one night, almost magically, it went down to it's normal size. The next day, I was able to wear jeans. !!! (I'd been living in sweatpants & loose shorts until that point.)

I understand being scared. Like you, this was my first surgery ever. I'd never been under general anesthesia before and was terrified of the whole process: surgery, hospital stay, recovery - the whole bit. During my pre-op visit, I made SURE to tell them that I did NOT want to be nauseous when I woke up after surgery. They gave me meds during the procedure (I believe) and put a patch of some sort behind one of my ears. I didn't have any queasiness when I woke up. :) I know they also gave me Valium right before they wheeled me into the OR and I remember feeling a little 'happy' as it took effect. (I'd never had Valium before.) I remember being in the OR and hearing the nurses say, "What time are we marking start of surgery? 11:03." The next thing I knew, I was waking up with my husband & sister standing there, and a nurse telling me it was over. They said they'd be moving me "up" to a different floor, which in my loopy state made me start singing the theme song from "The Jeffersons,", movin' on up.

ANYWAY - I totally understand your fears, but the surgery itself isn't bad. Mine took I think about 5 hours. You're totally knocked out, which is a good thing. You don't WANT to be awake for that! I really didn't experience much post-op pain, other than the gas build up, which went away. They gave me an Rx for Percocet and I never even bothered to get it filled. You will have soreness, but it's bearable. Laughing hurt, even a few weeks after surgery. My surgeon kept reassuring me that pain was normal. She kept saying, "Small incisions, but BIG surgery."

You will be fine. Try not to freak out (easier said than done, I know.) I'm a medical wimp, and if I got through the fears & the procedure itself, you will too. :)

Hang in there and keep posting questions, etc. here. There are MANY incredibly helpful, kind, generous souls here who will be happy to help in any way possible.
You're not alone - you can do this. :)
42 yr. old female
Rectal cancer Stage 3C T3 N1 M0 - Sept 2015
28 rounds radiation w/Xeloda - Nov - Dec 2015
2/17/16 - Surgery to remove rectal tumor, lymph nodes (2/20+), ovaries & fallopian tubes, temp. ileostomy
3/28/16 - 9/26/16 -12 rounds FOLFOX w/full oxi
Ileo reversal 10/27/16; Port removed 12/1/16
Lung mets confirmed 2/6/17
March-May 2017 - brain mets; brain rad. 5/9-5/29/17

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

Re: LAR surgery - what to expect

Postby mike1965 » Sat Aug 20, 2016 3:44 pm

Did your surgeon say why he could not do with a scope? The first surgeon I saw said it would have to be open because I was fat. I got rid of that surgeon. I found a great surgeon that said he could do it with a scope. I was in the hospital for three nights. The pain for me was not that bad. I did get an infection at the belly button incision after discharge but I was lucky the pain was minimal. I believe the pain was minimal because the surgeon used a scope and I had minimal incision. After the procedure my bowel movements were inconsistent. I would have diarrhea and constipation off and on. The chemo for me is harder than the LARS for me. I pray all goes well. Try to get it done with a scope if possible.
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

Swirdfish
Posts: 290
Joined: Sun Jun 19, 2016 3:57 am

Re: LAR surgery - what to expect

Postby Swirdfish » Sat Aug 20, 2016 6:01 pm

I'll ask my surgeon on Tuesday regards to open vs laparoscopic. I'm far from being fat, and think that I'm pretty fit etc due to my work. I build and repair heavy earthmoving equipment.

Maybe it's due to Tumor size. Mines a T3 and yours a T1. Can the cancer seed through laparoscopic? Vs open. Maybe I'll look into Tagamet I dunno if it's available in Australia.

I think RC is staged at the clinical stage unless surgery upstages me. So I'm hoping I remain the same. Anyone ever been upstaged?

3 more days of radiation can't wait. Bad stomach pains. My stoma surges with the pain. Very uncomfortable

Cheers
06/2016 Went in for colonoscopy came out with a tumor. Age 35
12cm from verge at junction. Rectal cancer.
Clinical stage T3 NO MO
Temp illestomy
Completed 5FU and Radiation
LAR surgery planned 13 Oct 2016
Completed ULAR surgery 11-10-2016.
0/22 nodes
pT3 N0 M0 R1
Stage 2A

Pathology reviewed and changed
ypT3 N0 M0 R0

Started folfox 21-11-2016
5-4-17 NED
Reversal 12-4-17

CatHair
Posts: 45
Joined: Mon Aug 17, 2015 11:09 pm

Re: LAR surgery - what to expect

Postby CatHair » Sat Aug 20, 2016 6:39 pm

Abdominal surgery is not fun, but being fit beforehand is an excellent advantage. You may wish to get a good therapeutic massage a couple of days before the surgery, to relax you. Talk a nice walk and do stretching exercises the morning of the surgery, and tell the anesthesiology team you want them to whisper encouraging words in your ears while you're under. Bring to the hospital music you enjoy and a means for listening to it; it will also help you when you get up and walk around and around the floor. Painkillers will be your friend.

As for returning to work, listen to doctor's orders and obey them. Period. You may be prohibited from lifting anything heavier than 10 pounds for a period of weeks. The last thing you will want to do is risk a rupture (and another trip to the surgical suite) because you think you can go right back to daily physical work. Your energy and stamina may not return to their previous levels for months, both from post-surgery recovery and from whatever your new innards will be demanding from you. Be patient with yourself and give yourself time to heal.

You'll do fine!
F 55 at Dx
Dx rectal cancer 7/22/2015
LAR with temp ileostomy 8/31/2015: T2N0M0
Ileostomy reversal 11/30/2015
NED 7/15/2016
Work full time, physically active
Wife, mom of two sons now 23 and 19 plus cats and dogs, daughter, sister
Wicked Brazilian samba-reggae drummer
So far, so good

Pita
Posts: 637
Joined: Wed Feb 10, 2016 3:48 pm
Location: So Calif

Re: LAR surgery - what to expect

Postby Pita » Sat Aug 20, 2016 10:19 pm

Hi SF,
Ok, I will tell you all about my surgery, long... :roll: At my first appointment with CR surgeon he looked at my PET/CT scan and said it looked like I could be a candidate for laparoscopic and robot surgery BUT that could change to an open surgery after insertion of the camera and he has a look around. Had a MRI on July 7 and he said it looked good BUT that could change. I looked up online and saw picts of all and asked him about training on the robot and was told that majority of CRS and hospitals do not have training in robot or laparoscopic, could that be the reason why your doc says "open"? Could it be because you have the stoma and bag already?
Had my LAR surgery on July 19th, anesthesiologist came into pre-op room and asked me if I wanted them to be in recovery ready with a nerve block or in my regular room after surgery. I wasn't sure, then nurse inserted my IV and I said ouch and he said we'll be waiting for you in recovery. :wink: Don't remember much being wheeled in, whatever they gave me in the IV worked quick. Pain after surgery in recovery was a 10, had the nerve block but it took a long time? to administer and kick in. Four hour surgery and my surgeon said that the surgery could not have gone better. He was able to easily remove the tumor and the surrounding lymph nodes. He didn't need to use the robot, it was done by laparoscopic and I didn't need a colostomy bag!!! That night got up and sat in a chair. Spent 2 nights in the hospital and could go home as long as I had a bowel movement. Doc said chew chew and chew more when I ate.
Big incision where they took the tumor out was really painful as well as inside my abdomen and have 5 small incisions. Nurse injected heparin to help prevent blood clots. Also took Tordal (anti-inflammatory), Neurontin for pain, Protonix for my gerd, Entereg to restore bowel movement. Doc would not let me take cintidine/Tagament but if I were you I would look into it, I took for 5 days before and started again when I got home from hospital.
Next day pain about 5-6, walked off and on all day. Occupational and physical therapists came to visit me and occupational discharged me since I was self sufficient, physical discharged me next day. Lots of diarrhea next day and unable to hold it, glad bathroom was really close. Home and I took strong pain pills for about a week and then lighter pain pills for 3 more days, occasional Tylenol now. Not supposed to lift anything more than 10 pounds, I walk now but still don't have a lot of stamina, bending over gets easier every day. Remember that I am double your age and will probably take twice as long to heal but I think I've done really well and it was much easier and not as painful as I imagined it would be. I would take it easy if I were you though, don't want anything to go wrong till you're mostly healed.
Good luck on Tuesday and hugs...
70yo Fem DX: 1/21/2016 RC Stage IV-Nodules lungs
MSS-Kras Wild-Lynch Synd Neg-Lung Biopsy 1/27/16-Port 2/19/16
MRI 7/7/16 Endometrial polyp found, watching LAR 7/19/16, No Ileostomy, Stage ypT3 N1
CT 11/7/16: Most mets stable,1 shrunk,1 new??
CEA Tests: 1/21/16=20, 12/22/16=5.3, 1/20/17=4.8, 2/15/17=6.2
9/20/16-1/24/17 Folfuri & Avastin
#10/10 Done
PET/CT 2/10/16-1/31/17=Some shrunk & growth to 2, Avastin failing ??? :evil:
2/21/17 Folfuri & Avastin

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

Re: LAR surgery - what to expect

Postby mike1965 » Sun Aug 21, 2016 12:51 am

I was upstaged after surgery. I went from stage 1a to Stage 3a. The evil cancer left the tumor and was in my lymph vascular system. I hope yours staging stays the same.
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

User avatar
Jacques
Posts: 579
Joined: Sun Dec 28, 2014 10:38 am
Location: Occitanie

Re: LAR surgery - what to expect

Postby Jacques » Sun Aug 21, 2016 2:32 am

If you're in Australia, you might be interested in this document, which is an Informed Consent for Rectal Cancer LAR

https://www.health.qld.gov.au/consent/documents/colorectal_19.pdf

Also:
http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=54658&p=433493#p433493

Jachut
Posts: 1134
Joined: Mon Sep 26, 2011 11:16 pm
Facebook Username: hutchinson@aanet.com.au

Re: LAR surgery - what to expect

Postby Jachut » Sun Aug 21, 2016 3:42 am

I always hesitate to answer this type of question because I really don't want to sound flippant, but I found ULAR really pretty easy. I had youth (42) and a very good physical fitness on my side, I was not overweight and I qualified for laparascopic surgery, nor was I yet sick, weakened or otherwise in poor shape. I still had high spirits and had survived chemoradiation without any major trouble.

So...... I believe it was an 8 hour surgery. It was horrendous when I woke up because they hang you upside down to get the rest of your guts out the way. DH said I was unrecognizeable, my face was so swollen, my head felt like a football. There was also some damage down to one of my sinuses so that breathing in room temperature air was incredibly painful and my nose just ran and ran for days. That wasn't comfortable. I had a morphine pump, I was in no real pain and I got up the next morning, nine or ten hours later and had a shower by myself AND blow dried and straightened my hair. I only used the pain pump for a day, I was walking laps of the ward on day 1 and I was raring to go when they sent me home on day 5. The worst part of it was the ileostomy and the crazy output I had, it was hard to cope with and I had no idea how much my stoma would shrink and the output settle.

I did suffer some pretty extreme weight loss which bothered everyone except me. Sadly, I point to cancer as the one time in my life that I liked my body. Anyway, I got home and yes, I had to take it easy for a little while - grocery shopping with someone in attendance for example, was really tiring. But within 3 weeks I ventured out for a very gentle jog of 3kms or so. And I was running my normal 8kms within six weeks, when I went away on holiday, went in the surf and on a boogie board etc.

For me, it just really wasn't much of a drama. I've had several more surgeries since and they have gotten progressively harder and taken longer to recover from even though they've been much smaller surgeries - ileostomy reversal, abdominoplasty, colostomy, hernia repair, I"m 6 years older, have gained a little weight and my core and muscle strength has suffered after so many surgeries so I tend to get injured when I run. So I run less, am less fit and recover more slowly.

AppleTree
Posts: 267
Joined: Fri Mar 18, 2016 8:16 am

Re: LAR surgery - what to expect

Postby AppleTree » Sun Aug 21, 2016 3:55 am

After my surgery to remove cancer and get a temp Ileostomy, I had an abdominal girdle. It was much more comfortable to wear it even though it was warm and the hospital has no A/C (it has been a hot summer!). It really helped with possible pain when coughing, sneezing or laughing!

I only remember going into the OR. I woke up in ICU and stayed there 3 days with morphine drips. I really do not remember any time the pain being overwhelming.
Diag Feb 5, 2016 Age 45
3 cm tumor 5 cm from verge
Radiation + Xeloda pills - 3000mg 5x week
3/14 - 4/16 - 25 sessions
Shrank just over 50% L nodes 0/13
Remove rectum with temp Ileo 6/17
Reversal 7/20 due to infection
Acute hepatitis August. Chemo cancelled
June to September 2016 - 58 days in hospital

2017
6/16, MRI shadow in lung
Pet - 6.6mm Met in Upper R lobe
7/30 VAT surgery Mass General/Boston
8/24 port
8/30 - 4/28 Folfox. 12 rounds
2018
June CT shows new lung Mets.
July/Oct PETs...CLEAR!

Swirdfish
Posts: 290
Joined: Sun Jun 19, 2016 3:57 am

Re: LAR surgery - what to expect

Postby Swirdfish » Sun Aug 21, 2016 5:06 am

Thankyou all for the big replys. This gives me a lot of questions to ask the surgeon on Tuesday. Hopefully I can go laparoscopic but seems the recovery time isn't too bad and the overall procedure is okay.

I really hope I'm not up staged? Should I get another scan before surgery? I'm not sure if it will show anything different.

I generally heal quite well and last time the only person keeping me in was the ostomy nurse.

I really don't know what else to say but that I'm counting down the days.
06/2016 Went in for colonoscopy came out with a tumor. Age 35
12cm from verge at junction. Rectal cancer.
Clinical stage T3 NO MO
Temp illestomy
Completed 5FU and Radiation
LAR surgery planned 13 Oct 2016
Completed ULAR surgery 11-10-2016.
0/22 nodes
pT3 N0 M0 R1
Stage 2A

Pathology reviewed and changed
ypT3 N0 M0 R0

Started folfox 21-11-2016
5-4-17 NED
Reversal 12-4-17

Swirdfish
Posts: 290
Joined: Sun Jun 19, 2016 3:57 am

Re: LAR surgery - what to expect

Postby Swirdfish » Sun Aug 21, 2016 5:30 am

Also on a positive side note.. How does a cancer DX change your life or lifestyle.

For me I'm thinking about selling all my investments, getting that fishing boat that I want, the 4wd I want and doing some house renovations for the family. Hey I might not see it through until 50 but why not enjoy life now while I'm young.

The 2yr old and 12yr old daughters would love a pool etc.

I've worked hard all my life I think after a cancer diagnoses it's time to enjoy it.

Anyone do anything similar? :D
06/2016 Went in for colonoscopy came out with a tumor. Age 35
12cm from verge at junction. Rectal cancer.
Clinical stage T3 NO MO
Temp illestomy
Completed 5FU and Radiation
LAR surgery planned 13 Oct 2016
Completed ULAR surgery 11-10-2016.
0/22 nodes
pT3 N0 M0 R1
Stage 2A

Pathology reviewed and changed
ypT3 N0 M0 R0

Started folfox 21-11-2016
5-4-17 NED
Reversal 12-4-17


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