Robotic Surgery

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Basil
Posts: 197
Joined: Thu Mar 16, 2017 12:33 pm

Robotic Surgery

Postby Basil » Fri Jul 28, 2017 4:32 pm

Anyone had this. I have a mid-rectum tumor that most mostly killed off with chemo. I'm having robotic surgery Monday that will remove most of my rectum but the surgeon says there's enough to stitch everything back together. He's doing this robotically, which I understand will help some, but it's still going to suck. Anyone have any similar experience?
40 y/o male, kids 6&9
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

Aqx99
Posts: 167
Joined: Fri Mar 31, 2017 7:28 am
Facebook Username: aqx99
Location: Pfafftown, NC

Re: Robotic Surgery

Postby Aqx99 » Fri Jul 28, 2017 5:10 pm

I had a robotic LAR on June 14th. I was out of the hospital on June 17th. I had minimal pain, even in the hospital. By the last day, I had not asked for pain meds at all. I currently have a temporary loop ileostomy and am going through chemo. I feel that my surgery was very successful, for what I have experienced so far.
Anne, 39
Stage IIIB Rectal Cancer
T3N1bM0
Diagnosed at age 39
2/21/17 Diagnosis
2/21/17 CEA 0.9 ng/mL
3/23/17 - 5/2/17 Chemoradiation, 28 treatments
6/14/17 Robotic LAR with temp loop ileostomy, ovaries and fallopian tubes removed, 2/21 lymph nodes positive
7/24/17 Started CapeOx
7/24/17 Diagnosed with precursor ovarian cancer
9/6/17 CA 125 11.1 U/mL
1/18ish Reversal

justin case
Posts: 4184
Joined: Sun Sep 04, 2011 8:26 am
Location: Katy, Texas

Re: Robotic Surgery

Postby justin case » Fri Jul 28, 2017 5:31 pm

If there is enough rectum left, as your surgeon said, robotic or not, a straight connect, has some getting used to. The key is if your sphincters, are intact. These are the muscles, that can hold your rectum together, until you have time to evacuate comfortably . With a reduced size rectum, your competency to hold waste may take a few years to rebuild. A straight connect will alter after time, and stretch to accommodate waste, but it takes a few years, and then may not be perfect. I wish I would have had an option like yours, 6 years ago, butt I'm alive 6 years later to comment !
:roll: :roll: :roll: :roll: :roll:
Michael
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012

Basil
Posts: 197
Joined: Thu Mar 16, 2017 12:33 pm

Re: Robotic Surgery

Postby Basil » Fri Jul 28, 2017 6:12 pm

Well, said awkward as it is to type this, the drs. said, welI I can't remember the exact terminology, but the import is that I have a very tight sphincter. Can barely tolerate a finger exam.
40 y/o male, kids 6&9
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

Basil
Posts: 197
Joined: Thu Mar 16, 2017 12:33 pm

Re: Robotic Surgery

Postby Basil » Fri Jul 28, 2017 6:20 pm

Aqx99 wrote:I had a robotic LAR on June 14th. I was out of the hospital on June 17th. I had minimal pain, even in the hospital. By the last day, I had not asked for pain meds at all. I currently have a temporary loop ileostomy and am going through chemo. I feel that my surgery was very successful, for what I have experienced so far.


Anne, you are my new favorite person. I was told to expect a three day hospital stay.
40 y/o male, kids 6&9
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

ElanF
Posts: 5
Joined: Mon Dec 05, 2016 9:07 am

Re: Robotic Surgery

Postby ElanF » Fri Jul 28, 2017 7:06 pm

Good luck, I had robotic LAR at MSKCC two years ago. I was in the hospital for 5 days, and then recovered at home for a few weeks. I did not have a temp ileostomy.

The worst part for me was illeus post surgery. Very painful cramping. Heating pads helped and toradol seemed to help too. Took about two days for it to go away.

benben
Posts: 214
Joined: Fri Apr 28, 2017 3:18 pm
Location: Washington State

Re: Robotic Surgery

Postby benben » Fri Jul 28, 2017 8:26 pm

I had Robotic Assisted LAR post surgery - pre chemo.
I don't really know if it was helpful for the Robotic assist or not.
What I can say is that surgery went pretty well. Even though I had robotic, they still had to give me a large c-section like incision.
This is where they removed the tumor, mine was close to 5 inches in length. They removed 8.2 inches of combined colon/rectum.
Only about 2 inches of my rectum was removed. I had very little pain post surgery. The only time I was in pain was during movement, especially anything that involved stomach muscles.
My advice, use your upper body/arm strength to lift yourself up without using the stomach muscles. I only took 1 pain pill post surgery on first day home.
I spent 4 days in hospital, although they told me I could go at day 3 - but I still had a drain in so wanted to wait for that to come out - which it did the following day.

As for bowel activity. The more rectum removed, the more issues there are with post surgery bowel movements.
I'm now 3 months and 11 days post surgery. My bowels have improved, especially during first 5 days of chemo treatment. I get slightly constipated and have only 1 or 2 movements a day.
Come day 6/7 it starts to get back to 5-8 for a few days as chemo is leaving the body. Then last few days its 3-6 movements a day usually. Right after surgery after coming home I was experiencing 12-16 movements a day. Yeah, really, that's a lot of time on the pot! I had a very hard time for about 5 weeks even going as the surgery internal swelling seemed to block off the colon area when sitting. I literally had to stand/squat during that time. Thankfully I've been able to sit since about 5 weeks. If you need to slow things down Imodium does help. I take a pill the night before, if I know I need to go somewhere the following day without having to be worried about mad dashes to the can.

The first few days after surgery, my stomach was really bloated - I was concerned as I was relatively flat stomached prior, but after a few weeks the swelling decreased and now I'm back to flat stomach - in fact probably flatter than pre surgery as I've lost about 20 lbs - 10 around surgery and 10 since chemo.

Good luck Basil,
May your surgery go smooth and you awaken to little to no complications.
----------------------
3/29/17 diagnosed CRC - 44 y/o Male
4/17/17 ULAR - Straight anastomosis - no ostomy.
Path: low grade T3n1m0 - moderate diff.
KRAS - NO, MLH1/PMS2/MSH6/MSH2 - Normal.
5/3 med port install
5/22 folfox - first treatment.
3rd treat, delayed - low ANC - reduced to 90% OXI
Granix given, Now Zarxio treatments every session.
Treatment 7 reduced to 75% OXI
Treatment 8 - NO OXI, just Luke and 5FU here on out.
Current - 10 treatments done, LOW RBC

tarheelmom
Posts: 157
Joined: Mon Mar 07, 2016 5:55 pm

Re: Robotic Surgery

Postby tarheelmom » Sat Jul 29, 2017 7:04 pm

My surgeon had an interesting view on the different ways of approaching a U/LAR case. His view was that some surgeons preferred robotic because the robot had articulated joints and it was more akin to traditional open surgery. So if a surgeon trained a lot via open procedures, she/he would have an easier time moving to a robotic procedure. In fact (again, this is just his opinion), he flat out said that most of the older surgeons leaned toward robotic surgery while the younger surgeons preferred a straight lap procedure since that was the focus of their training. I had a laparoscopic ULAR plus temporary ileostomy. It took about 5 hours. He did hand sew my colon to my anus through my anus so I guess that was a bonus procedure. 4 nights in the hospital. Participated in the ERAS (Enhanced Recovery After Surgery) protocol. No pain killers other than Tylenol. Surgery on a Tuesday. At Costco on Sunday. Back to work ~2 weeks after surgery. I thought the ileostomy reversal was a slightly more difficult recovery. Good luck.
52 y at dx, mom to 4
DX: RC on 2/22/2016
Stage I, T2N0M0, 0/32 LN
23 mm x 7 mm moderately differentiated invasive adenocarcinoma
3 cm from anal verge
4/12/16: ULAR, TME, & temp ileostomy
6/14/16: ileo reversal

hawkowl
Posts: 45
Joined: Sun Dec 14, 2014 5:29 am
Location: MN/FL

Re: Robotic Surgery

Postby hawkowl » Sat Jul 29, 2017 8:14 pm

I had a robotic APR plus iliac node dissection done 8/12/2015. I had only mild post op pain and was able to walk down 7 flights of stairs just 3 days post op. I know that without the robotic approach it would be difficult for the surgeons ( I had both a urologist and a colorectal surgeon) to access and remove all the nodes of concern. I was a little concerned this was more a gimmicky technology looking for a use, but now, after my speedy and pain free recovery I am a believer for sure.
Dx 12/2014 T3N2MX (iliac nodes) low rectal
12/2014-4/2015: FOLFOX (8 cycles)
4/2015-6/2015: 28 cycles of chemoradiation with xeloda
8/2015: Robotic APR with iliac node dissection; path showed ypT0,ypN0 (complete pathological response).
11/2015 scans clear, CEA 2.1
11/2015 parastomal hernia repair
3/2016 CEA 1.7

NHMike
Posts: 370
Joined: Fri Jul 21, 2017 3:43 am

Re: Robotic Surgery

Postby NHMike » Sat Jul 29, 2017 8:22 pm

benben wrote:I had Robotic Assisted LAR post surgery - pre chemo.
I don't really know if it was helpful for the Robotic assist or not.
What I can say is that surgery went pretty well. Even though I had robotic, they still had to give me a large c-section like incision.
This is where they removed the tumor, mine was close to 5 inches in length. They removed 8.2 inches of combined colon/rectum.
Only about 2 inches of my rectum was removed. I had very little pain post surgery. The only time I was in pain was during movement, especially anything that involved stomach muscles.
My advice, use your upper body/arm strength to lift yourself up without using the stomach muscles. I only took 1 pain pill post surgery on first day home.
I spent 4 days in hospital, although they told me I could go at day 3 - but I still had a drain in so wanted to wait for that to come out - which it did the following day.

As for bowel activity. The more rectum removed, the more issues there are with post surgery bowel movements.
I'm now 3 months and 11 days post surgery. My bowels have improved, especially during first 5 days of chemo treatment. I get slightly constipated and have only 1 or 2 movements a day.
Come day 6/7 it starts to get back to 5-8 for a few days as chemo is leaving the body. Then last few days its 3-6 movements a day usually. Right after surgery after coming home I was experiencing 12-16 movements a day. Yeah, really, that's a lot of time on the pot! I had a very hard time for about 5 weeks even going as the surgery internal swelling seemed to block off the colon area when sitting. I literally had to stand/squat during that time. Thankfully I've been able to sit since about 5 weeks. If you need to slow things down Imodium does help. I take a pill the night before, if I know I need to go somewhere the following day without having to be worried about mad dashes to the can.

The first few days after surgery, my stomach was really bloated - I was concerned as I was relatively flat stomached prior, but after a few weeks the swelling decreased and now I'm back to flat stomach - in fact probably flatter than pre surgery as I've lost about 20 lbs - 10 around surgery and 10 since chemo.

Good luck Basil,
May your surgery go smooth and you awaken to little to no complications.


That sounds overall pretty smooth - a PITA but that's what we're all dealing with. I don't know whether or not my surgeon uses Robotic assist but I will have no objections if she does.
06/23/17: ER rectal bleeding; Colonoscopy+Biopsy
07/13/17: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm.
Xeloda 3,400 mg/day + radiation 07/31/17 - 09/08/17.
CEA 2.7; after 14: 1.9; after 28: 1.8.
KRAS Mutant KRAS p.Gly12Asp
10/06/17: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%).
Surgery Scheduled: 10/30/17

Basil
Posts: 197
Joined: Thu Mar 16, 2017 12:33 pm

Re: Robotic Surgery

Postby Basil » Sat Jul 29, 2017 9:24 pm

My surgeon is the section chief of colorectal surgery at MDAnderson. The proof is in the pudding, so to speak, but based on my course of treatment I have the utmost respect for his judgment. I hope his resume supports his skill with a scalpel, and the robotic stuff.
40 y/o male, kids 6&9
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

justin case
Posts: 4184
Joined: Sun Sep 04, 2011 8:26 am
Location: Katy, Texas

Re: Robotic Surgery

Postby justin case » Sun Jul 30, 2017 2:16 pm

Basil wrote:My surgeon is the section chief of colorectal surgery at MDAnderson. The proof is in the pudding, so to speak, but based on my course of treatment I have the utmost respect for his judgment. I hope his resume supports his skill with a scalpel, and the robotic stuff.

Someone once told me, if you're going to have cancer, Houston is your best bet for survival. I have a lot of respect for the strides MD Anderson has made in respect to cancer , not only in Houston, but achievements that affect the whole world.
I would trust you are in excellent hands ! 8) 8) 8)
Michael
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012

Basil
Posts: 197
Joined: Thu Mar 16, 2017 12:33 pm

Re: Robotic Surgery

Postby Basil » Sun Jul 30, 2017 11:56 pm

Surgery is at three tomorrow. I'm very hungry. Nervous as hell too. But it must be done of course.
40 y/o male, kids 6&9
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

JJH
Posts: 164
Joined: Mon Apr 24, 2017 7:26 am
Location: Europe

Re: Robotic Surgery

Postby JJH » Mon Jul 31, 2017 2:15 am

Basil wrote:Well, said awkward as it is to type this, the drs. said, welI I can't remember the exact terminology, but the import is that I have a very tight sphincter. Can barely tolerate a finger exam.

Perhaps it would be a good idea to obtain an accurate, official pre-surgery baseline measurement of your sphincter strength so that you have something to compare with after surgery in case there are problems later on due to nerve damage or trauma during surgery.

There are several ways to measure sphincter strength using ano-rectal manometers.

http://www.healthcommunities.com/digestive-system-tests/anorectal-manometry-motility.shtml
DX 2012: Stage IIc
Locations: upper-rectum T4b + mid-sigmoid T4b
Surgery: Open LAR + temp ileo
TX: chemo/rad (28 days) + Xelox (3 cycles)
Ileo reversal
5 years surveillance
7/3/2017: Final 5-year report -
"complete remission ... cured'

JJH
Posts: 164
Joined: Mon Apr 24, 2017 7:26 am
Location: Europe

Re: Robotic Surgery

Postby JJH » Mon Jul 31, 2017 2:15 am

duplicate post
DX 2012: Stage IIc
Locations: upper-rectum T4b + mid-sigmoid T4b
Surgery: Open LAR + temp ileo
TX: chemo/rad (28 days) + Xelox (3 cycles)
Ileo reversal
5 years surveillance
7/3/2017: Final 5-year report -
"complete remission ... cured'


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