The Colon Club

Hi all,

My colorectal surgeon is saying he can reverse my temporary ileostomy after I’ve been off adjuvant chemo for only a week, but my oncologist said he wouldn’t recommend considering it sooner than a month after last chemo. He suggested you really don’t want to be dealing with reversal recovery and chemo recovery at the same time.

I’m normally inclined to trust my surgeon more on surgical matters... So for those who have done this - how long were you instructed to wait? (Assuming most folk are keen to reverse as soon as possible!)

Thanks,
Rob

The end of chemo was about mid-June and my surgery was at the end of July so about six weeks for me. I also wanted some time between the end of chemo and reversal as I had stuff to do that I had put off while going through chemo. The surgery is a lot easier on you than the LAR unless you're bowels don't wake up. I walked five miles after the surgery and nine miles the day after. I didn't get out of bed the day of my surgery, without assistance and walked maybe 67 steps.

I waited 2 months after finishing adjuvant Xeloda, before the temp ileostomy takedown surgery.

I would also be slightly concerned about any residual immunosuppressive effects of the chemo
interfering with wound healing after just a week ?????
Seems a bit too soon IMO.

Best wishes
CRguy

Thanks for the replies guys! CRguy I think you’re on the money - I questioned my onc and he said his main concern would be going into surgery with low WBCs/neutrophils. I think I might give it the month - last thing I need now would be a bout of febrile neutropenia and sepsis.

Cheers
Rob

Not that I'm in any way qualified to answer your question, but I think that it's always best to err on the side of safety.

TinaFish wrote:Not that I'm in any way qualified to answer your question, but I think that it's always best to err on the side of safety.

Thanks TinaFish, good advice! For one more month I think I can be patient

Rock_Robster wrote: . . . my oncologist said he wouldn’t recommend considering it sooner than a month after last chemo . . .

Hi Rob,

FWIW, my onco-liver-surgeon also wanted to allow for at least a month of recovery between the end-of-chemo and anyfollowing surgery. I did CAPOX, but would be surprised things are different for FOLFOX / other chemo regiments.

Best wishes, Leon

One other aspect is preparation for life after reversal. I didn't really prepare for it and it was very rough on the other side. It may be helpful to have various supplies, knowledge and even foods to make the adjustments on the other side.

LeonW wrote:

Rock_Robster wrote: . . . my oncologist said he wouldn’t recommend considering it sooner than a month after last chemo . . .

FWIW, my onco-liver-surgeon also wanted to allow for at least a month of recovery between the end-of-chemo and anyfollowing surgery. I did CAPOX, but would be surprised things are different for FOLFOX / other chemo regiments.

Thanks Leon, and indeed - I waited a month after both the liver resection and the rectal surgery (well 3 weeks, close enough), hence my surprise when the surgeon said he only needed a week.

I had a jpouch due to rectal cancer, but I can tell you that waiting a month is what I would recommend. I know with regular colon cancer it is a lot easier, but that was one of the most difficult month's of my life. I know you want to get rid of that bag ASAP, but your body really will be a lot happier waiting.

Rock,

I waited a month after chemo for surgery. CRguy hit the nail on the head. Risk of infection is very high with low WBC/Neutrophils. Also healing is an issue. Your surgeon is tripping if he thinks a week out of chemo is a good time to do surgery very surprised he said that, but he is not an oncologist, but typically they all know this if they been doing this a long time.

Anyways good luck, reversal does suck with the new normal/pooping issues, but it gets better. Some days are bad, most days are good. Don't be afraid the first week is hell, or 2....You might be going 25-40 times. It gets better and quickly you will be going 10-25 times, then 1-10 times. Sometimes once a day, those are godsends LOL...

I think me and you are very close on the same thing. I had one metastasis to my liver which they did both surgery at the same time, rectum and liver resection.

Thanks Rikimaroo! Indeed we are walking a very similar path, albeit you’re a bit ahead of me. Even down to being in the modest NRAS group, and the DVT club. How are you doing these days?

Thanks for the feedback re surgery. Indeed my surgeon really confuses me sometimes. He is very capable -
Director of Cancer Surgery at the only integrated cancer hospital in Australia, chair of their Lower GI Tumour Board, US & UK board-certified colorectal surgeon, trained at St Marks & the Cleveland Clinic, currently supervising 4 PhD candidates... then he comes out with something like that! I have to think either he knows something hardly anyone else does (unlikely?), or maybe I’ve misunderstood...

Rob

Wow that's quite a surgeon. My surgeon is Dr. Steven Wexner Clevenald Clinic. He is the director of the Colorectal Surgery Dept here in South Florida Weston, Cleveland Clinic brand. He is world renowned. Glad you have a capable surgeon.

You know I am doing good mostly, have the recurrence MRI scheduled for tomorrow to see exactly specifically how close to pelvic wall it is. If its not on it or close at all my current surgeon will remove it, its 2cm x .9 I think. If it is on or too close to wall, then he thinks I should go to MSK, MD Andersen or Cleveland Clinic OHIO, where they have intraoperative radiation for highest chance of cure.

He doesn't do surgery unless he sees it as curative intent, which we will determine tomorrow I really hope it looks good for him to do it. Because my insurance don't cover out of state I think, its an HMO....But once of the best in Florida.

Still dealing with pooping but things have been better the last few days, getting more of a blowout which is what you like, because then your mostly done. I think the Imodium prescription Loperamide is much better then lomotil, but everyone is different.

Thanks Rikimaroo, indeed it sounds like an extremely capable surgeon you have there. Sorry to hear of the recurrence but glad you have a plan to tackle it: including heading to MSK if necessary. Best wishes for a good result.

Interesting re loperamide. Is the prescription version different? Loperamide 2mg is OTC here, and usual first line for diarrhea. Lomotil is prescription-only and usually only used if loperamide is inadequate.

Cheers
Rob

Yeah its the 2mg but prescribed, I will take a look and let you know.