LAR surgery - what to expect

[Jacques]

may I ask what should I expect. ... but I'm more interested in the procedure itself and its effects afterwards.

If you are having a procedure to remove a tumor in the rectum, then the effects after the procedure will likely fall in the area they call LARS (Low Anterior Resection Syndrome). The effects of LARS are well known and are summarized here:

Low Anterior Resection Syndrome
http://colonrectalsurg.wustl.edu/en/Patient-Care/Low-Anterior-Resection-Syndrome

In your Tuesday meeting with the surgeon, I would recommend bringing up the question of LARS and to ask what he intends to do in order to minimize your LARS Syndrome effect.

As the name implies, LARS problems originate in the surgery itself and are related to what was removed or damaged there in the rectum when the malignant tumor was removed.

There are known surgical procedures for minimizing these problems, such as Sphincter Sparing Operations. I think it would be worthwhile for you to discuss with your surgeon the various approaches he plans to take to minimize the necessary and collateral damage to the important structures in the lower rectal area (i.e., to the sphincter muscles, to the autonomic nerve sheaths, the feedback nerves that connect the sphincter with the rectum, the various uro-genital structures in the area -- seminal vesicles, genital and urinary nerve connections -- etc.) I think you should also ask him exactly where your tumor is located and what is the prognosis for successful removal of a tumor in that particular location.

Images "A", "B", and "C" below show where the incisions would be made to do a Total Mesorectal Excision (TME) for a tumor located in the mid-rectum area for a female patient.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057635/bin/11605_2014_2528_Fig1_HTML.jpg

You could ask your surgeon where your tumor is located and where (how low) he would intend to make the lower cut. This is what makes a big difference in the range of bowel management problems that you will eventually have to cope with from LARS: Lower cuts made somewhere in the upper two-thirds of the rectum are not as devastating as lower cuts made somewhere in the lower third of the rectum. This is why it is so important to know exactly where your tumor is located and from there exactly where the surgeon intends to make the lower cut. The lower the cut, the worse the eventual bowel management symptoms

[Swirdfish]

Well the meeting with the surgeon went well, the sphincter will be spared, so a very low down cut. I did mention laparoscopic vs open, and he suggested open is a lot better in regards to possible reccurance in the future, due to recent studies. However he can do the top half laparoscopically. I guess I'll just go full open.

Date is planned and I'm looking forward to it. 8 week break first.

[Jachut]

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?

Given that I was 42 when diagnosed and had 3 kids under 15, no No taking it easy for me, we were in the thick of things. I've returned to work and living the same lifestyle as before - too busy, too stressed, not enough time to eat right, too much alcohol and coffee. And parents getting very elderly on top of all of that. And because its so full on, I don't stop and smell the roses, or think how lucky I am to be here or any of that stuff people do if they actually have some spare time!

I was stage II though, have every expectation of never having a recurrence. And I guess I did just have a holiday in Europe.

[Swirdfish]

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?

Given that I was 42 when diagnosed and had 3 kids under 15, no No taking it easy for me, we were in the thick of things. I've returned to work and living the same lifestyle as before - too busy, too stressed, not enough time to eat right, too much alcohol and coffee. And parents getting very elderly on top of all of that. And because its so full on, I don't stop and smell the roses, or think how lucky I am to be here or any of that stuff people do if they actually have some spare time!

I was stage II though, have every expectation of never having a recurrence. And I guess I did just have a holiday in Europe.

It's great to hear you are on the mend and back into the thick of it!!! I always thought cancer doesn't make a sick body, but a sick body makes cancer.

I myself plan to smell the roses and change my habits. Yes I drank, diet was poor and a lot of coffee too. However never been overweight.

Perhaps we got sick for a reason?? Was our body telling us something.

[AnnClare]

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?

Given that I was 42 when diagnosed and had 3 kids under 15, no No taking it easy for me, we were in the thick of things. I've returned to work and living the same lifestyle as before - too busy, too stressed, not enough time to eat right, too much alcohol and coffee. And parents getting very elderly on top of all of that. And because its so full on, I don't stop and smell the roses, or think how lucky I am to be here or any of that stuff people do if they actually have some spare time!

I was stage II though, have every expectation of never having a recurrence. And I guess I did just have a holiday in Europe.

It's great to hear you are on the mend and back into the thick of it!!! I always thought cancer doesn't make a sick body, but a sick body makes cancer.

I myself plan to smell the roses and change my habits. Yes I drank, diet was poor and a lot of coffee too. However never been overweight.

Perhaps we got sick for a reason?? Was our body telling us something.

Like most folks, I don't think I'll ever know why I got cancer. I was healthy, fit, active, never smoked, never overweight, zero health issues prior to Dx. My diet wasn't "perfect" (if there even is such a thing) but far better than the Standard American Diet. My surgeon told me that my tumor had likely developed 8-10 years before I was Dx. Looking back in that time frame, I was in a very stressful job, which I eventually left only to land another, somewhat less stressful job. I also used to force myself to do grueling workouts which, in hindsight, I no longer believe are healthy. Exercise is great, but beating yourself ragged in the name of "fitness" - not so much. (When your palms sweat at the mere thought of your upcoming workout, clearly it's not a good sign.)

My onc and surgeon have both given me an excellent prognosis. No 'expiration date,' so to speak. I hope and pray I'll never have a recurrence, but like anything in life, only time will tell. I do a lot of positive affirmations, telling myself things like, "All of the cells in my body are completely healthy." I figure it certainly can't hurt. The mind-body connection is strong and there's seems to be increasing evidence that our thoughts greatly impact our physical health.

Also, since beginning this crazy process, my diet has begun to include more "junk" than ever before, simply because there have been times (usually infusion day & the two following pump days) the only food I want is considered crappy: fries, pizza, chicken tenders, Pop Tarts. When I'm off the "juice" and feeling like myself, then the normal cravings come back: salad, fish, baked potatoes, and various home-cooked meals, courtesy of my sweet mother-in-law. (Her lasagna is SO good!)

I try not to think too far ahead. Not because I believe I "won't be around," but simply because none of us knows what the future holds, in any aspect, not just our health. I TRY to be mindful and live in the moment, but there are days I struggle and of course think, "What will happen after chemo? After my reversal surgery? What if this, and what if that?" The sucky thing is that our lives will never be the same again. I do get sad when I think of my pre-Dx life. Damn, did I have it good and I just didn't know it. With that in mind, I try to appreciate any and all good things as they come my way, no matter how small or insignificant they would seem to an "outsider."

[Rob in PA]

Don't necessarily go in debt, but yes do things to make memories with your children. I'm still here four years after being told I wouldn't be. I bought a new truck, a quad, and drove solo across country for almost three weeks. Loved it. Glad I did it. Butt, no I'm still here and find myself a little more responsible...in moderation . Yes, live life but don't sacrifice your families needs...you never know how long you'll be atound