Robotic surgery and LAR syndrome

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chrisca
Posts: 237
Joined: Wed Dec 07, 2011 10:35 pm
Location: Portland, Oregon

Robotic surgery and LAR syndrome

Postby chrisca » Mon Nov 26, 2018 9:07 pm

At a recent GI appointment my specialist mentioned that the growing popularity of robotic procedures for rectal resection will likely increase the incidence of LAR syndrome. He said, "It's likely in the future you're going to have a lot of company." The reasons are that the robotic procedure tends to favor doing a high ligation of the inferior mesenteric artery (where the important nerves are to control the braking reflex after a BM) and also that the robotic instruments allow better removal of lymph nodes, which are also near the critical nerves. Surgeons figure that removing the nodes cuts down on recurrence risk so if it's easy to remove them, why not?

So if you're considering a robotic procedure, be aware of these risks. If an open procedure would allow a low ligation of the IMA, it may be well worth the temporary discomfort to avoid a lifetime of problems later.
Male, false negative colonoscopy age 48
DX: 12/2010 rectal cancer age 51
Stage T3N0M0 2 cm from anal verge
neoadjuvant rad/chemo Xeloda
Rectal resection (open surgery) straight anastomosis
Xeloda round 2
ileostomy reversal 11/2011
Successful adhesion X-lap 8/2013
Ongoing LAR syndrome but NED 7 years

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CRguy
Posts: 9673
Joined: Sun Feb 10, 2008 6:00 pm

Re: Robotic surgery and LAR syndrome

Postby CRguy » Mon Nov 26, 2018 10:10 pm

I think this is a hugely important issue which folks need to be aware of.

surgical technique / protocol / issues WILL determine our outcomes
and patients NEED this info

My LAR technique ( TME ) was specifically developed to reduce neurological complications
...and to that extent I am not 100% perfect ... BUTT a lot better off than I could have been.

It all relates to where the tumors are and what can be done about them

knowledge IS power

just bumped your migraine topic as well
thanks for the good conversation points and input here

Cheers
CR
Caregiver x 3
Stage IV A rectal cancer/lung met
11 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

KathyLynn
Posts: 56
Joined: Thu Aug 31, 2017 3:40 pm
Location: Rock Hall, MD

Re: Robotic surgery and LAR syndrome

Postby KathyLynn » Tue Nov 27, 2018 7:53 am

I had robotic LAR and I remember the doctor mentioning that he had an urologist and another doctor there that lit up the nerves near the surgery site. They had all the nerves lit up so they could avoid any issues. I believe this is why I don’t have much of an issue.

KathyLynn
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)
7/12/2018. CEA 2.0.

lakeswim
Posts: 111
Joined: Sat Mar 31, 2018 9:37 am

Re: Robotic surgery and LAR syndrome

Postby lakeswim » Tue Nov 27, 2018 8:22 am

Thank you so much for this info. I think my surgeon wants to do my surgery robotically.
50 - F (Just turned 50 so writing this # for the first time - ACK!)
Mom to 2 kids
RC - dgns March '18 at age 49 (colonoscopy aftr blood in stool)
Adenocarcinoma
10-11 cm from anal verge
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Next steps.....scans in Jan will determine if W&W is an option or surgery

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susie0915
Posts: 872
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Robotic surgery and LAR syndrome

Postby susie0915 » Tue Nov 27, 2018 10:03 am

lakeswim wrote:Thank you so much for this info. I think my surgeon wants to do my surgery robotically.

You most likely will do pretty well since your tumor was 10-11 cm from anal verge. My tumor was 4-5 cm from anal verge so most of my rectum was removed. I am doing pretty well and have found by doing daily tap water enemas(30 minutes per day) and a couple lomotil every day allows me to live a normal life. I would suspect that you will have enough rectum left to avoid many of the LARS symptoms.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoidoscopy/only scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change
11/18 CEA .6

lakeswim
Posts: 111
Joined: Sat Mar 31, 2018 9:37 am

Re: Robotic surgery and LAR syndrome

Postby lakeswim » Tue Nov 27, 2018 10:12 am

Hmmm. The last time I spoke with my surgeon (and another surgeon elsewhere), they both told me that taking only PART of the rectum "causes more trouble than it's worth" (at least this is how I understood what they said) and they planned to take my entire rectum (and uterus, given where the tumor is). So, it seems, at least to these surgeons, it didn't seem to matter where my tumor is - they're planning to take it all. I need to send my surgeon messages to clarify things so I can research properly.
50 - F (Just turned 50 so writing this # for the first time - ACK!)
Mom to 2 kids
RC - dgns March '18 at age 49 (colonoscopy aftr blood in stool)
Adenocarcinoma
10-11 cm from anal verge
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Next steps.....scans in Jan will determine if W&W is an option or surgery

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GrouseMan
Posts: 771
Joined: Mon Aug 12, 2013 12:30 pm
Location: SE Michigan USA

Re: Robotic surgery and LAR syndrome

Postby GrouseMan » Tue Nov 27, 2018 1:27 pm

lakeswim wrote:Thank you so much for this info. I think my surgeon wants to do my surgery robotically.


Ask him how many he has done! If its only a few dozen vs the number he has done open - that might be an indication as to his experience. My wife's surgeon was a pioneer in the use of robotic procedures and was a teacher to others. He had done several hundred before my wife had hers done. She recovered pretty quickly, and her BM issues had more to do with chemo. But she had colon cancer in the Sigmoid area not rectal so likely not at risk for LARS syndrome.

Unfortunately I think in some instances LAR in some surgeons hands might not be done as skillfully as in others. As with all things cancer related - you do yourself the most service by asking hard questions of your care providers.

Good Luck

GrouseMan
Last edited by GrouseMan on Tue Nov 27, 2018 3:48 pm, edited 1 time in total.
DW 53 dx Jun 2013
CT mets Liver Spleen lung. IVb CEA~110
Jul 2013 Sig Resct
8/13 FolFox,Avastin 12Tx mild sfx, Ongoing 5-FU Avastin every 3 wks.
CEA: good marker
7/7/14 CT Can't see the spleen Mets.
8/16/15 CEA Up, CT new abdominal mets. Iri, 5-FU, Avastin every 2 wks.
1/16 Iri, Erbitux and likely Avastin (Trial) CEA going >.
1/17 CEA up again dropped from Trial, Mets growth 4-6 mm in abdomen
5/2/17 Failed second trial, Hospitalized 15 days 5/11. Home Hospice 5/26, at peace 6/4/2017

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susie0915
Posts: 872
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Robotic surgery and LAR syndrome

Postby susie0915 » Tue Nov 27, 2018 3:44 pm

lakeswim wrote:Hmmm. The last time I spoke with my surgeon (and another surgeon elsewhere), they both told me that taking only PART of the rectum "causes more trouble than it's worth" (at least this is how I understood what they said) and they planned to take my entire rectum (and uterus, given where the tumor is). So, it seems, at least to these surgeons, it didn't seem to matter where my tumor is - they're planning to take it all. I need to send my surgeon messages to clarify things so I can research properly.

I am not sure. It has been my understanding that having more rectum gives better results. My issues were clustering where I would go a little bit frequently. Since I have nothing to hold stool until ready to evacuate it is necessary it comes from the colon right to the anal verge. I don't understand why he would take the whole rectum when he doesn't need to. I would definitely clarify with him. Maybe I am wrong.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoidoscopy/only scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change
11/18 CEA .6

lakeswim
Posts: 111
Joined: Sat Mar 31, 2018 9:37 am

Re: Robotic surgery and LAR syndrome

Postby lakeswim » Wed Nov 28, 2018 9:10 pm

KathyLynn wrote:I had robotic LAR and I remember the doctor mentioning that he had an urologist and another doctor there that lit up the nerves near the surgery site. They had all the nerves lit up so they could avoid any issues. I believe this is why I don’t have much of an issue.

KathyLynn


Thanks, KathyLynn. I never considered others would be involved. Great question to add to my list. Thanks to you - and everyone - for your perspective.
50 - F (Just turned 50 so writing this # for the first time - ACK!)
Mom to 2 kids
RC - dgns March '18 at age 49 (colonoscopy aftr blood in stool)
Adenocarcinoma
10-11 cm from anal verge
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Next steps.....scans in Jan will determine if W&W is an option or surgery

Big Jay
Posts: 32
Joined: Fri Jun 17, 2016 5:41 pm
Location: Baltimore, MD

Re: Robotic surgery and LAR syndrome

Postby Big Jay » Thu Nov 29, 2018 10:57 pm

My Surgeon used the robot and performed the high-ligation. I've had some minor LARS but, overall, things have been quite manageable.
DX at 45yo 6/9/16, 2.4cm tumor, 9cm from Anal Verge, 6/27/16
Clinical staging IIIC, CEA 3.1 7/1/16
30x Chemorad 8/5/16 - 9/16/16
CT/MRI/Scope => CCR 11/1/16... Rolling the dice on Watch & Wait
Snake Eyes: Tiny regrowth at scar 11/1/17
LAR 1/17/18: Path = 3mm tumor, 0/12 nodes Med Onc doesn't recommend chemo.
Reversal 4/17/18

lakeswim
Posts: 111
Joined: Sat Mar 31, 2018 9:37 am

Re: Robotic surgery and LAR syndrome

Postby lakeswim » Fri Nov 30, 2018 8:30 am

Big Jay wrote:My Surgeon used the robot and performed the high-ligation. I've had some minor LARS but, overall, things have been quite manageable.


BigJay ....
I PM’d you days ago. Did you get it? I’m not sure the system sent it as the messages are in my outbox. Still trying to figure that out.
50 - F (Just turned 50 so writing this # for the first time - ACK!)
Mom to 2 kids
RC - dgns March '18 at age 49 (colonoscopy aftr blood in stool)
Adenocarcinoma
10-11 cm from anal verge
Stage 3a - T4N0M0
FOLFOX May -Sept '18 (8 rounds total chemo - but stopped Oxaly after severe reactions in Round 5 or 6)
Capecetabine + Radiation - 28 sessions (Oct - Nov 2018) (Stopped Cap after 20 days due to intolerance)
Next steps.....scans in Jan will determine if W&W is an option or surgery


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