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surgery question

Posts: 544
Joined: Jun 2004

Hi everyone,

The last week has been crazy. One daughter graduated eighth grade and another got married last Saturday. The wedding was beautiful. I went away for a few days with a friend which was very relaxing, but now it's back to reality and surgery scheduled for Monday.

My question has to do with what the surgeon wants to remove.

The tumor is high in the rectum. All the scans show that it has not spread and no lymph node involvement. The original scans showed that it had infiltrated to the presacral space. I have had chemo and radiation. The surgeon is planning on removing the entire sigmoid colon and the upper part of the rectum. When asked why he was going to remove the whole sigmoid, he said it was necessary to make sure he had clear margins. I don't understand this, given where the tumor is and have left a message for him, but was wondering if anyone could shed some light on this for me. Has anyone had the whole sigmoid removed for a rectal tumor.

Also, even though I haven't posted often, I have been reading the posts and want everyone to know how much I appreciate the positive attitudes that you have. It really helps!

Thank You,

kangatoo's picture
Posts: 2115
Joined: Feb 2004

Hiya Jamie--In some ways I understand why the surgeon is saying he will remove the whole sigmoid colon.It really depends on many things but I can only tell you of my experience.
I was found to have 3 tumours, however only one was cancerous, this was higher up just above the sigmoid colon, where it becomes the descending colon.The other 2 were benign but lower down in the sigmoid colon.
MY surgeon originally thought he would only need to take a small portion of sigmoid colon and the section just above where it becomes the descending colon.It was explained to me that he may well take more depending on what other possible evidence of cancer he found during surgery.I was also told I may end up with a colostomy(temporary)
The highest tumour went thru the bowel wall and was also a partial bowel blockage.
I was told after surgery that he removed my sigmoid colon and the descending colon up to where it becomes the transverse colon(the part that crosses your body from left to right)
The reason he took so much was that he wanted to be very, very sure he had removed all the cancer as well as the area that polyps could grow and possibly become cancerous.
He called this "taking more" --clear margins
I guess that is a way of doing things to give us the best possible chance to be free of the cancer.
His main explanation for not being concerned about removing too much was that we can survive very well with little--and in some cases--no colon at all.
After 6 months of chemo to "clean up any remaining cells" I am now in remission.
I think you are in the situation that your surgeon will give you the best possible chance of being cancer free and if that means removing your sigmoid colon to be closer to 100% sure I think he will do so.
Jamie--with much of my colon gone my bowel habits are pretty well back to normal and I really don't notice that I have had some removed.
Do not be too worried--you can function fine without it.
We pass on our very best for monday Jamie--will be thinking of you .
If you are able to arrange someone to post here on your behalf and report your progress I am sure we will all be waiting for news of your surgery.
LUV and huggs----it will all be over before you know it!
kanga n Jen---from OZ

jsabol's picture
Posts: 1156
Joined: Dec 2003

Hi Jamie, Best of luck to you on Monday with your surgery; and congratualtions on the happy life events. I'll be sending extra prayers your way that day.
The amount of colon that needs to be removed seems hard to understand. I had a polyp the size of a pencil eraser, and lost 6 inches of my colon. My dad had a larger tumor, close to his rectum, and a smaller one a little highter up; they took his most of the sigmoid and the descending colon. He used Metamucil to help firm things up, but had essentially normal bowel funtion otherwise. It seems that any tissue in the area is susceptable to additonal spread, so better to be safe.
Again, good luck and have a nice weekend. I was in the hospital for 5 days following surgery, so we may not hear from you for a bit, but do let us know how things go.
Regards, Judy

Anonymous user (not verified)

Hi Jaime:

My husband had a right sided colon (actually two of them right next to each other) that was located in the lower portion of the cecum colon extending into the ileocecal value (connection between the small intestine and the colon). Not only did Bert have a portion of the small intestines removed plus the value, he had 13 inches of his right colon removed....to obtain the clearest margins they could get and thus reduce the chance of recurrence. I think the bigger the margin (area of cancer free tissue), the better. Hope this helps a little bit.


Posts: 1
Joined: Mar 2005

Greetings Monika!

My diagnosis shows tumor in the cecum area, so the surgeon plans to remove the right section of the colon. My question is regarding the "ileocecal valve" == if it's removed with the resection, what are the noted effects?

Any info will be most appreciated.

Green Jeanie

littlejulie's picture
Posts: 311
Joined: Mar 2004

I'll be thinking of you on Monday. Just think - you'll be cancer free!!! that's GREAT!!! my mom has had 5 weeks of chemo & radiation just like you. her surgery is in 2 weeks!! i wish you all the best and im looking VERY forward to hearing how well your doing! i'll say a prayer for you.

julie :)

Moesimo's picture
Posts: 1080
Joined: Aug 2003

I have to agree with the others. the surgeon will remove as much as he thinks is needed to obtain clear margins. I had surgery one year ago, 6/26 for stage 3 [2 out of 12 nodes]. My rectal cancer was so low that there was only 2 cm of clear margin on the distal side {anus}. there were 12 cm of clear margins. I just got out of the hospital for another small bowel obstruction.

Posts: 1961
Joined: Aug 2003

Wishing you all the best for your surgery. I'll be thinking of you! As others have said, I believe clear margins are very very important. i don't think the dr will take any more than he has to - but you do want those clear margins. Best wishes,

Posts: 835
Joined: Apr 2004

I appreciate how radical it sounds to remove so much bowel for something that is in itself not a large tumour but all the studies show that taking more rather than less is best. Whether he removes a samll or large amount of the sigmoid colon will have little effect on how the remaining bowel will function or how you will feel but it will affect your chances of teh tumour coming back. The worst outcome in these situations is for teh surgeon to remove the bowel and send it off for histology (microscope examination)only to find out he hasn't got 'clear margins'. This means he has cut through areas where there is tumour and probably left some behind. This leads to a far worse prognosis. It is far better to be safe than sorry in these situations and although they can always go back in to remove more the first time is the best chance of getting a good result.

Best of luck with it all. I too am getting myself prepared for removal of my rectal cancer next month. The waiting is the hardest- it will be great to get the damn thing out and get on with life again! So I know how you feel!
PS I have assumed your surgeon is a bloke which most are still but I apologise if it sounds sexist!

kangatoo's picture
Posts: 2115
Joined: Feb 2004

Hey Steve--don't yu forget to remind us as the dreaded day gets near mate so 'ol kanga can send off a "rainbow" to yah.
The waitin sure is the hardest time I think yu will ever experience--then--all of a sudden it will be all over.
Let me know if you have any concerns about the surgery Steve--maybe I can help in that area.
cheers n best wishes---luv kanga n Jen

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