LAR vs Excision

scohow66

Hi folks - I had posted something on LAR surgery a few days ago...continuing to assess things.  T2N0M0 clinically tagged.  Assessing LAR or Transanal excision.  Seems to come down to going with a less invasive surgery with better post op quality of life, but with the unknowns on lymph involvement vs LAR with possible LARS, temp ileostomy, longer recovery road...but with knowing lymph status.  If positive, then that is the worry area same as with the unknown worry from excision.  Surgeon has discussed both options and seems tied to my tolerance for risk and unknowns.  I know LAR is the "standard", but given my stage is it overkill vs doing excision?  Surgeon also seems more concerned with distant recurrence than local with either option, especially if LAR with positive lymph.  If positive and post op chemo is there still reason to be worried??  Appreciate any input.

 

Tx

lp1964

Dear Friend,

Even though I had the more involved APR open surgery I'll tell you what I know. The pelvic area is so small that often the surgeon has bad visibility with his/her hands in there. With laparoscopic surgery they watch everything through a huge monitor and the visibility is often better. It also depends on the surgeon's comfort and experience. Have different opinions and go with the most comfortable to you. I interviewed 4 surgeons and I'm glad I did. They way I see post up chemo is this: I want to make sure that I did everything in order to prevent the cancer coming back. God forbid I had recurrence it would comfort me to know that I did everything I could.

All the best. 

Laz

mozart13

Which surgery?

These days lar could be done laparoscopiclly, good think would be to find some one that does only that, they are usually specialized in trans anal excission as well. what does your mri say, your answer is there, if lymph node is involved, its milion dollar question, positive or negative, one doesnt know till biopsy done.

Did you alerady have chemo/rad as pre treatment, than re-staging, radiation works long after treatment finished, 

chemo following operation is standard to kill any free floating cells, I am in simillar situation, I opted for W&W approach, had cCR, started folfox couple of days ago.

My choice could be seen as risky, operation is still considered as king, your and my stage is considered curable with operation, it is still impossible to see small microcells present, diagnostic tools just dont exist yet.

Good luck!