Colorectal Surgery (Rectal) post op?

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ocstacy
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Colorectal Surgery (Rectal) post op?

Postby ocstacy » Mon Jul 17, 2017 11:57 pm

Hi all,

Just wanted to see how the colorectal surgery post op experience went for some of you that had Rectal surgery. Did you have good experience, bad experience? Did they get all of it? Temp Colostomy, permanent colostomy? Please share. My mother's oncologist mentioned that she will not give her the XELOX after srugery because of her age. She will give her Xeloda again. I heard that XELOX kicks your butt.

Thank you for sharing :D
Caregiver/daughter to dear mother age 78, dx 5/09/17 because of me!! :wink:
Rectal CA Stage 3 low-grade adenocarcinoma- 6 cm
Neoadjuvant start 7/10/17 ended 08/16/17
3D Lap. surgery @ Keck USC, Dr. Sang Lee 10/17/17 temp ileostomy
11/1 hospitalized abscess/hernia - home 11/06/17 antibiotics
NO LYMPHS INVOLVED! NEAR PATHOLOGICAL RESPONSE! YAY! :shock:
Took her last chemo med 05/10/18! Ileo reversal 07/24/18
1st BM after reversal 07/25/18 Anal Fissure 8/15/18
Me:1st Colonoscopy age 38. 08/17 Benign polp.

ozziej
Posts: 239
Joined: Thu May 21, 2015 8:35 pm

Re: Colorectal Surgery (Rectal) post op?

Postby ozziej » Tue Jul 18, 2017 4:36 am

Hi Stacy
I had an ultra low anterior resection for rectal cancer in 2015. The surgery took about 3 hours. Post op I had a drain tube, a urinary catheter and a temporary ileostomy. I had a morphine pump for pain relief for about 5 days. Up and showered the following day then the catheter was removed. Began walking that day. Fluid diet then soft diet then low residue diet. Fortunately I had no trouble with ileus. A little difficulty with urinating which persisted for a few weeks then settled down. The ileostomy was easy to manage and I had lots of help from the stoma nurse. Discharged after 10 days. I had the ileostomy reversed 3 months later (that is a whole other story). I think the most important factor with a rectal resection is having a really skilled colorectal surgeon. I'm in Australia but if you are in the US then I believe that you look for a colorectal board certified surgeon. There are also lots of suggestions for things that you and your mum can do to ease the journey but that is a whole other post and may be more useful closer to the time of surgery. Right now she needs to get through chemo/radio and regain some strength. Best wishes to you both.
F 56 dx 11/14 Stage 1 RC (post EMR)
No neo-adjuvant or adjuvant chemo/RD
3/15 ULAR (open) temp loop ileo
5/15 ileo reversal
NED and hoping to stay that way!! : )

[Ana & Alex]
Posts: 96
Joined: Tue Feb 14, 2017 5:14 pm
Location: Austria

Re: Colorectal Surgery (Rectal) post op?

Postby [Ana & Alex] » Thu Jul 20, 2017 12:06 am

Dear Stacy,

It is awesome that you are getting as much information as you can to be able to help your mom in the best possible way.

You will find a lot of valuable experiences in the forum if you search form the term "post operative rectal".

Here is my detailed experience regarding the first few days after surgery: viewtopic.php?f=1&t=57952&hilit=alex+meet

The surgery was the easiest part until now for me. But I'm not your typical patient and I've made a very radical decision, which offered me the least chance of complications and the best possibility of a cure.

I hope it all goes well with your mother.
Stay strong and all the best for surgery and adjuvant chemo,

Ana
Dx @ 29 yo. Mum (2 y.o.) & Wife

12/2016: Rectal AdenoCa G2. CEA 4.3. RAS Wild. MSS. IIIB.
01 - 03/2017: 28 RTx + CHT 2,5 g/d Capecit.
03 - 06/2017: Suplemments and Cimetidine.
05/2017: TME/TAMIS + permanent Colostomy CEA 0.5
05/2017: ypT2N2aM0 (4/15), good cCR, limited pCR
06 - 8/2017: 4x CapOx 3,5 g/d (2x Oxi reduced to 80%)
09 -11/2017: 3x Capecit. monotherapy 4g/d
12/2017: Aspirin, Vit. D3, Curcumin, Multivitamin.

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Jacques
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Location: Occitanie

Preparation for rectal surgery

Postby Jacques » Thu Jul 20, 2017 3:16 am

It's good that you are pro-actively collecting information to help your mother. Although your mother's surgery will not be for another couple of months, there are a few things that you could do right now in preparation.

  • Peri-operative Tagamet/ Cimetidine - There is a lot of information about the possibility of using Tagamet / Cimetidine before, during, and after rectal cancer surgery in order to provide further protection against recurrence of cancer. You would need to talk to the surgeon about this in advance, because the use of Tagamet / Cimetidine is still not included in the "standard of care" for colo-rectal cancer, even though many patients in the past have found it to be useful.

    Here is a link to a topic containing 35 posts discussing this possibility:

    Recent data on Cimetidine / Tagamet
    http://coloncancersupport.colonclub.com/viewtopic.php?t=50181&p=383124#p383124
    .
  • Type of surgery - You have not mentioned what kind of surgery will be done. Will it be 'open surgery' or 'laparascopic surgery' ? This can make a difference in the post-operative recovery period.
  • Location of tumor within the rectum - You have not said where, exactly, the tumor is located. It can make a difference whether it is in the upper rectum, mid-rectum, or lower rectum. It can also make a difference which side of the rectum the tumor is in: Is it in the front wall of the rectum, the back wall of the rectum, or on the left/right side of the rectum?
  • Temporary ileostomy - In my opinion, it is likely that the surgery will result in a temporary ileostomy. This is because the tissue where the anastomosis junction will be made has been radiated and will be somewhat fragile (i.e., a bit soggy or mushy in nature) and will need some additional time to heal without being disturbed by the passage of daily stool. Temporary ileostomies are used in order to take the neo-rectum 'off-line' for a few months in order to to give it enough time to heal properly.
  • Low Anterior Resection Syndrome LARS - After surgery (and after reversal of any temporary ileostomy) there is a likelihood that the patient will experience LARS. There are some things that can be done in advance in order to minimize the impact of this problem -- for example, doing pelvic floor rehabilitation exercises or sphincter exercises daily over a period of 4 months or more.

So, these are some of the issues that you could discuss with the surgeon in the next month or so.

Lee
Posts: 6207
Joined: Sun Apr 16, 2006 4:09 pm

Re: Colorectal Surgery (Rectal) post op?

Postby Lee » Thu Jul 20, 2017 8:48 am

I have a permanent colostomy, my choice. Radiation while very effective, destroyed 2/3 of my rectal muscles, thus I was tied to the toilet anytime I ate (this was 13 years ago, a lot of advancements/improvements since then). Anyway getting that bag gave me my life back. Also the deal was I gave my surgeon carte blanc to take all she wanted, just be sure to get all the cancer. I believe she was successful. A few years ago, I was told I was "cured".

The best advice I can give your mom, following surgery, be sure to walk, walk, walk those hospital halls, and be sure to continue walking even after you get home. It really does help with the healing process.

All the best to your mom,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 16 years and counting!

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juliej
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Re: Colorectal Surgery (Rectal) post op?

Postby juliej » Thu Jul 20, 2017 3:46 pm

Agree with Lee on walking. Even if it's very slooow walks around the hospital ward, it really does speed up the healing process. It looks like you're going to an excellent surgeon (Dr. Sang Lee at KeckUSC) so you've got that covered! :D

Also, I wouldn't worry about your mom only getting Xeloda. It's what does the heavy lifting in Xelox anyway. If the surgeon says she will need a temporary ileostomy, make sure they mark the spot on her tummy ahead of the surgery date. That way the stoma and bag won't interfere with her clothing. Also, make sure to ask for an ostomy nurse to train your mom and you on how to take care of the skin around the opening to the bag, as well as the basic mechanics of how to change the bag, etc. The bag seems really weird at first, but you get used to it. I hiked, mountain climbed, and ran several miles a day, all with a bag. Wearing tights or a maternity belly band (available at places like Target) can help disguise it under more form-fitting clothes. The good part is any Xeloda-induced diarhea goes into the bag, so you don't have to make all those potty stops in public places!

My experience: good surgery with no complications, clear margins, temporary ileostomy with reversal about 5 months later. Make sure your mom uses the two month post-radiation break to gain strength for the surgery. Have her eat healthy foods, stay hydrated, and go for walks or whatever she can do to build up some stamina.

Hugs to you and your mom!!!
Julie
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

Basil
Posts: 275
Joined: Thu Mar 16, 2017 12:33 pm

Re: Colorectal Surgery (Rectal) post op?

Postby Basil » Thu Jul 20, 2017 3:58 pm

I'm going in July 31. I have a mid-rectum tumor that had 80% regression after six rounds FOLFOX. Surgery is minimally invasive robotic performed by Dr. Chang at MDAnderson. Because I had no radiation, Chang told me there's a 50% chance he will not install a temp bag. That all sounds well and good, relatively speaking, but I have no idea what to expect. Any thoughts would be appreciated.
40 y/o male (now 46), kids 11 & 14.
Dx 3/16/17, rectal cancer s3,t3,n1,m0
PROSPCT trial (FOLFOX in lieu of chemorad)
FOLFOX 4/5/17 - 6/26/17
LAR 7/31/17, temp ileo
pathological complete response
Adjuvant chemo cancelled (IDEA Study)
Ileo reversed 9/25/17
NED
1 year scans - clear
2 year scans - clear
3 year scans - clear
4 year scans - clear
5 year scans - clear (considered cured)

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juliej
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Re: Colorectal Surgery (Rectal) post op?

Postby juliej » Thu Jul 20, 2017 4:38 pm

Basil wrote:I'm going in July 31. I have a mid-rectum tumor that had 80% regression after six rounds FOLFOX. Surgery is minimally invasive robotic performed by Dr. Chang at MDAnderson. Because I had no radiation, Chang told me there's a 50% chance he will not install a temp bag. That all sounds well and good, relatively speaking, but I have no idea what to expect. Any thoughts would be appreciated.

Basil, you have an advantage in not having had radiation, which thins rectal tissue and makes it brittle. Since you're going to MD Anderson, ask about their Bowel Management Program, which has helped many members here recover from rectal surgery. Try this page for starters and click on the Bowel Management Guide.

https://www.mdanderson.org/patients-family/diagnosis-treatment/emotional-physical-effects/bowel-management.html

You might have some "clustering" (having to go to the bathroom right after you've already went) for the first several weeks and you'll have to be careful about eating foods until you learn which things overexcite your guts. If something causes diarrhea, just eliminate it from your diet for a few weeks, then reintroduce it and see how it goes. As times goes by, you'll be able to eat more types of foods without little to no issues.

Best of luck with your upcoming surgery on July 31st! Hope you have a successful surgery with no complications and a fast and painless recovery!
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

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ocstacy
Posts: 264
Joined: Mon Jun 19, 2017 11:29 pm
Facebook Username: stacy

Re: Colorectal Surgery (Rectal) post op?

Postby ocstacy » Wed Jul 26, 2017 1:21 am

Wow, this is so amazing so thank you to everyone! My mom's oncologist thinks I'm a genius cause I have all of you wonderful people supporting me on what to learn and expect. Thank you so much!

Peri-operative Tagamet/ Cimetidine - There is a lot of information about the possibility of using Tagamet / Cimetidine before, during, and after rectal cancer surgery in order to provide further protection against recurrence of cancer. You would need to talk to the surgeon about this in advance, because the use of Tagamet / Cimetidine is still not included in the "standard of care" for colo-rectal cancer, even though many patients in the past have found it to be useful.

Here is a link to a topic containing 35 posts discussing this possibility:

Recent data on Cimetidine / Tagamet
http://coloncancersupport.colonclub.com ... 24#p383124


Type of surgery - Laparoscopic surgery
Location of tumor within the rectum - Location is pretty low. Dr. can literally feel it with a rectal exam. Also it's 6 cm if that helps.
Temporary ileostomy - Surgeion mentioned temp bag.. and the possibly he will hand sew her a new rectum lol .. crazy.
Low Anterior Resection Syndrome LARS - Thank you.
Caregiver/daughter to dear mother age 78, dx 5/09/17 because of me!! :wink:
Rectal CA Stage 3 low-grade adenocarcinoma- 6 cm
Neoadjuvant start 7/10/17 ended 08/16/17
3D Lap. surgery @ Keck USC, Dr. Sang Lee 10/17/17 temp ileostomy
11/1 hospitalized abscess/hernia - home 11/06/17 antibiotics
NO LYMPHS INVOLVED! NEAR PATHOLOGICAL RESPONSE! YAY! :shock:
Took her last chemo med 05/10/18! Ileo reversal 07/24/18
1st BM after reversal 07/25/18 Anal Fissure 8/15/18
Me:1st Colonoscopy age 38. 08/17 Benign polp.

scohow66
Posts: 33
Joined: Fri Apr 07, 2017 9:54 am

Re: Colorectal Surgery (Rectal) post op?

Postby scohow66 » Thu Jul 27, 2017 4:04 pm

Hi Stacy - I had robotic LAR in April. Was for very low tumor (6 cm from anal verge). Was a T2N0M0. Surgery took about 4-5 hours and I was inpatient for 3 nights. Was up out of bed within few hours after surgery and walked a lot in hospital. Had catheter and a drain tube in stomach, all came out prior to leaving hospital. Also, had temp ileostomy. Took me a good 2-3 months to feel myself again. Developed a lot of discomfort in the anal area. Stayed away from opioids and stuck with tylenol and ibuprofen. Measured progress in weeks vs days, but overall I was able to start eating and light exercise. I am now waiting on the ileostomy take down scheduled for October.

Best of luck,

Scott
52 Year old male
Dx with RC 10/2016 (T2N0M0)
Port implanted 11/2016
Rad with 5FU December 2016-January 2016
LAR robotic with temp loop ileo 4/2016
ypT0N0M0 - cPR to chemo/rad
Ileostomy reversal 10/2017
LARS

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ocstacy
Posts: 264
Joined: Mon Jun 19, 2017 11:29 pm
Facebook Username: stacy

Re: Colorectal Surgery (Rectal) post op?

Postby ocstacy » Tue Aug 01, 2017 2:12 am

I had robotic LAR in April. Was for very low tumor (6 cm from anal verge). Was a T2N0M0. Surgery took about 4-5 hours


That is pretty impressive. I researched the best surgeon on the west coast. My mom is super nervous as she has never had surgery before and she is 77. She is trying to avoid the surgery because she thinks the radiation shrunk it so bad along w/ the Xeloda. What she doesn't undrerstand is that the surgeon needs to cut the area around it too so it will get all of the tumor and spread. It's a long process. She will have the laparscopy but not robotic. The dr. said that his co dr. does the robotic, he said he stays away from that. He made it sound like he could save her rectum with a temp bag. Thank you and good luck. :|
Caregiver/daughter to dear mother age 78, dx 5/09/17 because of me!! :wink:
Rectal CA Stage 3 low-grade adenocarcinoma- 6 cm
Neoadjuvant start 7/10/17 ended 08/16/17
3D Lap. surgery @ Keck USC, Dr. Sang Lee 10/17/17 temp ileostomy
11/1 hospitalized abscess/hernia - home 11/06/17 antibiotics
NO LYMPHS INVOLVED! NEAR PATHOLOGICAL RESPONSE! YAY! :shock:
Took her last chemo med 05/10/18! Ileo reversal 07/24/18
1st BM after reversal 07/25/18 Anal Fissure 8/15/18
Me:1st Colonoscopy age 38. 08/17 Benign polp.

Basil
Posts: 275
Joined: Thu Mar 16, 2017 12:33 pm

Re: Colorectal Surgery (Rectal) post op?

Postby Basil » Tue Aug 01, 2017 3:53 am

Hello, it's 3:47 am Houston time and I am writing from a recovery room at MDAnderson, just having most of my rectum removed. My first surgery ever.

Pain is there but manageable with drugs. I have a temp bag, catheter and drain all running in me so I don't think I'll try and stand up just yet.

The good news is the docs are happy with what they found during surgery although biopsy will tell the whole tale. Doc said I could be outta here in two days, maybe three.
40 y/o male (now 46), kids 11 & 14.
Dx 3/16/17, rectal cancer s3,t3,n1,m0
PROSPCT trial (FOLFOX in lieu of chemorad)
FOLFOX 4/5/17 - 6/26/17
LAR 7/31/17, temp ileo
pathological complete response
Adjuvant chemo cancelled (IDEA Study)
Ileo reversed 9/25/17
NED
1 year scans - clear
2 year scans - clear
3 year scans - clear
4 year scans - clear
5 year scans - clear (considered cured)

James65
Posts: 383
Joined: Thu Mar 06, 2008 9:41 am
Location: Exeter, NH
Contact:

Re: Colorectal Surgery (Rectal) post op?

Postby James65 » Tue Aug 01, 2017 8:01 am

Hi,
I had surgery in 2006 after six weeks of chemo/rad and received a permanent colostomy. I had a rough recovery because of the radiation doing a number on the tissue surrounding where the tumor was. Very frustrating, but I did come through. The best things for me were walking (couldn't believe how painful it was at first, but incredibly helpful), keeping up my nutrition, using pain meds to help ease moving around, patience, and being able to ask and receive help from people. Friends and family were also a very important source of support and distraction.

All the best,
James
Diagnosed with stage III rectal tumor (though probably late stage II) January 2006.
Chemo/Radiation
Full APR Surgery
Folfox Chemo
So far NED.
Oops. Liver tumor diagnosed 10/13 after elevated CEA. Liver resection for 5cm tumor 12/6/13. So far so good.
Oops again, one tumor in each lung diagnosed 8/8/16. One too small to deal with and the other resected in late September. Wait and watch for now.
Oops, another lung Met in upper left lobe on edge of previous resection scar 11/11/19.


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