kmalbany,kmalbany wrote:I had a T1 tumor removed recently through an endoscopic procedure.
It was a sessile tumor, well-differentiated, no lymphovascular invasion, no tumor budding, but likely grew deeper than 1mm. They could not grade it for depth based on the SM1, 2, 3 system because of how it was removed (you can imagine my eyes are glazed over from reading studies).
ozziej wrote:I had a supposedly benign sessile low rectal polyp removed by EMR. Turned out it was malignant, moderately differentiated but with no lymphovascular involvement, T1/2. Margins were clear. I was immediately referred to a colorectal surgeon. He gave me two options: ULAR or APR (would only know once he was in there), or watch and wait (no chemo or radiation). He emphasized that not harvesting lymph nodes meant there was a possibilty of microscopic invasion that couldn't be identified by scanning. He said that if it did return that the success rate of salvage surgery was about 50%. He asked me if i was a gambler. I wasn't, so i chose the surgery. Ended up with a ULAR so no permanent colostomy but I had a temporary ileostomy for about 12 weeks. O/25 lymph nodes positive. The ileostomy was relatively easy to manage. I had this reversed about 2.5 years ago. No sigmoid colon or rectum, straight coloanal anastomosis. Life since reversal has been a rollercoaster. LAR/ULAR carries a real risk of ending up with LARS (Low Anterior Resection Syndrome), which I now have. LARS of varying degrees is an outcome for about 80% of people with low rectal cancer who have an LAR/ULAR. The lower the anastomosis the more likely you will have LARS. Given that your polyp was in the sigmoid colon your odds of having normal function after surgery are better, though not 100%. Since my surgery i have done my own extensive research on low rectal cancer. Seems to me that most research is definitely being directed towards watch and wait, with chemo used for T1/2 where the plan is not to do a resection. There are also alternate full thickness procedures that fall short of resection but have good oncological outcomes without the risk of poor functional outcomes. There is very little research into improving treatment for LARS. Many people with LARS report that once the reversal is performed they receive little support from the colorectal world and are perhaps better served by gastroenterology.
This is an agonizing decision which only you can make. My heart goes out to you as i remember how difficult it was for me to choose. It is hard to find psychological support when many professionals are still operating under the belief that all colorectal surgery results in a permanent stoma. There is now a predictive tool available online called POLARS. It enables you to get an estimate of the likelihood of your surgery resulting in LARS. This may help in your decision making. I wish you all the best whichever option you choose.
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