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APR surgery for low rectal tumor

Posted: Wed May 15, 2019 1:27 pm
by _Jelen90
Hi everyone,

I need some feedback from people who had the APR surgery for low rectal tumor. Our surgeon told us it was the only option for my husband but I am also seeing a lot of people on here had the LAR surgery even with a very low tumor so I am kinda confused. I know it's a major surgery with a lot of risks and a super long recovery. I am scared to death to be honest.My husband had his first follow up 6 weeks after his chemorad was finished and the tumor went from 3 cm to less than 1.5 cm. The surgeon wants to wait another 7 weeks as he thinks it might shrink even more.

Re: APR surgery for low rectal tumor

Posted: Wed May 15, 2019 2:38 pm
by Eleda
I had a TATME for a 3cm tumor 2.5xm above AV, Minimal down time
Temporary illeostomy
So it's not the only option..... but there may be other factors at play as to why they want to go this road for ur husband

ADELE x

Re: APR surgery for low rectal tumor

Posted: Wed May 15, 2019 3:01 pm
by Gravelyguy
I was told by the first 2 surgeons that APR was the only option. I was ok with that if that allowed me to spend more time with my family. It wasn't until I was referred to Mayo for my liver mets and was asked to see one of their colorectal surgeons that the possibility of ULAR was even brought up. The liver surgeon referred me to THE guy who thought it might be possible to do it. After 4 rounds of chemo and short course radiation they were able to avoid APR. According to the discharge Dr. not very many surgeons could have done what he did.

Dave

Re: APR surgery for low rectal tumor

Posted: Wed May 15, 2019 3:18 pm
by _Jelen90
Eleda wrote:I had a TATME for a 3cm tumor 2.5xm above AV, Minimal down time
Temporary illeostomy
So it's not the only option..... but there may be other factors at play as to why they want to go this road for ur husband

ADELE x


Where do you live Adele ??? We are in Edmonton, Canada...I'm not even sure if that's offered here :S

Re: APR surgery for low rectal tumor

Posted: Wed May 15, 2019 3:52 pm
by Eleda
Hi,,,
I'm living in Ireland,,,,!!
It's not a new technic , but very effective,,,,
I had my surgery in May and was n Spain on holiday in July/Aug and Oct ... Not a bother ( appart from the bag slipping in the heat :evil: :evil: :evil:

Maybe you could reaserch and see if there is a surgon in ur area doing lap surgery,,,,,
Is it a board certified Colorectal surgon you are attending??

This is so important,,it's such a delicate area and nerve preservation surgery is the main thing

ADELE X

Re: APR surgery for low rectal tumor

Posted: Wed May 15, 2019 4:03 pm
by _Jelen90
Eleda wrote:Hi,,,
I'm living in Ireland,,,,!!
It's not a new technic , but very effective,,,,
I had my surgery in May and was n Spain on holiday in July/Aug and Oct ... Not a bother ( appart from the bag slipping in the heat :evil: :evil: :evil:

Maybe you could reaserch and see if there is a surgon in ur area doing lap surgery,,,,,
Is it a board certified Colorectal surgon you are attending??

This is so important,,it's such a delicate area and nerve preservation surgery is the main thing

ADELE X



Thanks for your reply Adele :)..he is a board certified colorectal surgeon and he's supposed to be one of the best ones. We have an appointment with him on the 31st and will have to clarify a few things I think..plus his surgery is booked very close to my due date...fun fun

Re: APR surgery for low rectal tumor

Posted: Thu May 16, 2019 1:13 am
by ozziej
Having had a ULAR myself, and now having Low Anterior Resection Syndrome (LARS), I would suggest that you fully explore the possibility that your husband may well end up with LARS if his tumour is extremely low.. Recent research suggests that people with a permanent colostomy have as good as, or even better, quality of life than those who have major LARS. It's important to understand that the lower the anastomosis, the greater the risk of LARS. With a ULAR, we are talking in the range of upwards of 80% who will develop LARS. Add in radiation and that increases the risk again. It is a lottery. Hopefully your husband might be in that small percentage who don't develop the syndrome. If fear of the bag is an issue, I would suggest reading Miss Molly's excellent post re permanent colostomy on this board.
Best wishes for a smooth recovery whichever direction you take.

Re: APR surgery for low rectal tumor

Posted: Thu May 16, 2019 4:05 am
by hawkowl
I had an ultra low rectal tumor and a complete response to neoadjuvant chemo followed by chemo radiation. I was offered watch and wait but because I had suck extensve lymph node involvement including distant nodes I was more comfortable with surgery.

LAR surgery would have almost certainly led to bad LARS due to my very low lying tumor so I chose APR plus colostomy and have zero regrets. The bag is no big deal and allows me to travel and me be active. No bathroom? No problem

Re: APR surgery for low rectal tumor

Posted: Thu May 16, 2019 9:50 am
by NHMike
Radiation continues working after the last dose so that is why the surgeon wants to wait.

I had a LAR and have LARS issues. The surgeon does offer a Colostomy alternative but I want to see if I can make things work without it.

Re: APR surgery for low rectal tumor

Posted: Thu May 16, 2019 10:42 am
by aja1121
I would also recommend a second opinion. APR is is a big surgery and takes quite a while to recover, so I'd want to be 100% sure that a less invasive option wouldn't be possible before moving forward. My husband originally had LAR, then APR due to local recurrence.

Re: APR surgery for low rectal tumor

Posted: Thu May 16, 2019 7:00 pm
by Soccermom2boys
I had to have an APR based on the location of my tumor butting up against the anal sphincters. I did the chemo radiation and my surgery was seven weeks afterwards, but not a complete response so I continued on with the surgery as planned. It is initially crushing to hear you will have a permanent colostomy, but over three years later I find it isn’t all that inconvenient, especially compared to those who do suffer from LARS. I went in to the surgery at my healthiest (the irony, eh?!) with running and walking 5-10 miles per day as I wanted my best chance at a decent recovery and it was not as catastrophic as you might think for the level of surgery that it is. I was easily walking a mile in the hospital corridors by the time I was discharged five days later. I do anything and everything I was doing before the surgery as far as activities go. Would I rather my original plumbing, sure? Butt I am happy to be here three plus years later still chugging along. :D I am not trying to tell your husband which way to go, only that life with a permanent colostomy can be just as good as life after a ULAR. Good luck to your husband in his decision. In all honesty, I am glad I didn’t have to decide, it was not an option based on my response to the chemo radiation.

Re: APR surgery for low rectal tumor

Posted: Thu May 16, 2019 9:45 pm
by hart2hart
My Pete had VLR Tumor 11/11. We had 4 opinions.
2 said 80/20 we can save the sphincters, one said 50/50
and said APR. We went with one fantastic, ace-surgeon who spent almost 4 hours hand-sewing the connection since a stapler would not have worked. My hero.
Pete is doing great.....so anyone who has a Very Low
Rectal Tumor please get a few if not more opinions. We realized pretty quick some Doctors could not be bothered to just try. Dr James MCClane from Connecticut with always be my hero along with Dr Kemeny and Dr D’Angelica from MSK! Our lives are fun and full!


Julie and Pete
Stamford, CT