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Old 03-19-2008, 03:29 PM   #1
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who do colon resection

My mother has a colon polyp discovered 8 months back. Two months back, doctors tried to remove the polyp through colonoscopy but not successfull as they said it is too big. They took biopsy that turned negative. Did a CT Scan that was clear. They did Blood CEA test that was also normal. Now the gastroenterologist has refered to surgeon for colon surgery. My question is: Is it required to be done by only colorectal surgeon or a general surgeon can do it as good? Another question, the first colonoscopy states the polyp is 28 cm from anal verge. The later one says it is 15 cm from anal verge. Do not know why there is discripency? And my last question: on scale of 1 to 10, how complex the colon resection procedure is? Do I have to bring her to Canada/USA for surgery. Presently she is being treated in Pakistan. I live in Canada. Thanks, Imran

 
Old 03-20-2008, 12:42 PM   #2
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Re: who do colon resection

If it were my mother, I would ONLY allow a colorectal surgeon to take the polyp out with a colon resection. I cannot tell you why the difference in the position of the polyp. It may be that because it is so big, that when one scope says 15 cm up it is really one end of the polyp and the other is ???the other end, although that would be a VERY large polyp (13 cm!). Regardless, even a polyp as low as 15 cm is at the top end of the rectum. IF the tumor was suspicious or cancerous (which you say it is not) the surgeon would take a large portion of the rectum. I do not know,however, how much, if any, of the rectum they MIGHT take with a benign tumor. However, since it is a POSSIBILITY that a portion of the rectum would have to be taken out to get the polyp out, I would then want a colorectal specialist to do the job. There are many nerves, ligaments, tendons, etc. in the immediate area and everything in the pelvis is in a tight space. Fortunately, women have a slightly bigger area for the surgeon to work with-hips are wider for childbearing. At any rate, while a general surgeon could do the surgery, there is risk of other 'trauma' to the surrounding area if the operation is not undertaken carefully. I would STRONGLY suggest finding a specialist to do the surgery. I have no idea what the health care system is in Pakistan. If you feel comfortable with the doctors/hospitals/diagnostic facilities, etc. then she is probably fine. I can't possibly tell you what the difficulty is, but it is not that uncommon of a surgical procedure. However, still I would try to have a specialist perform the surgery.
Hope this helps
Jaynee

 
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Old 03-20-2008, 02:01 PM   #3
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Re: who do colon resection

I can understand your concern for your mother. Unfortunately where I live there were no specialists to do my husbands surgery...and his was a large tumour. However, the general surgeon here has done many such surgeries and, even though there were some complications, he did an excellent job! I think it depends on your level of comfort as to whether you bring her closer to you for the surgery.

All the best.
__________________
Husband dx July 2003, advanced rectal cancer stage 111C; myself dx July 2006 indolent lymphoma; husband dx February 2010, stage 2 prostate cancer.

 
Old 03-20-2008, 04:57 PM   #4
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Re: who do colon resection

Thanks Jaynee and 'Nassau One'. It tell it should be a colorectal surgeon. I am not sure howmany of certified colorectal surgeons are there in that hospital **REMOVED** One of the gastroenterologist seen my mother reports say he can take out this polyp with colonoscope! And take the biopsy of whole thing to see if it was cancerious at all. My worry is, if it happen to be cancerous and is cutout using colonoscope, will not it spread? In this scenario, can I rely on this GI and let him cut polyp out?

Last edited by Mod08; 03-20-2008 at 05:35 PM. Reason: Do not post urls/websites per the posting policies.

 
Old 03-29-2008, 03:10 PM   #5
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Re: who do colon resection

I think after reading my story, you will lean toward the colon resection for your mother. My doctor found a polyp in my colon that was 5 cm in size. During the colonoscopy, they did a biopsy which showed a "precancer", not cancer. Because of the size of the polyp they recommended a colon resection which was done by a gastrointestinal surgeon. I stayed in the hospital for 5 days. On the day I was supposed to leave, the doctor came in to remove my staples. He told me that the pathology report showed that the polyp was cancerous. I asked him how this could be if the biopsy during the colonoscopy showed that it was negative. He said that the edges of the polyp could have not shown to be cancerous but the center of it was. The cancer had also spread to my lymph nodes. (10 of 13 nodes were positive.) I'm currently undergoing chemotherapy. Even though there is likely cancer in some of my remaining lymph nodes which we are treating with chemotherapy, my CEA markers are normal. (1.7) This shows that blood tests can be normal even on a cancer patient. I know several people who have had cancerous polyps removed during a colonoscopy. I'm am much happier knowing that the source of my cancer has been surgically removed. I think I would always worry that the cancer would come back to the same area. Hopefully, the chemo will be effective on my lymph nodes and I can get on with my life. I wish the best for you and your mother. These decisions aren't easy.

 
Old 04-11-2008, 11:26 PM   #6
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Re: who do colon resection

Hi Imran,
I had colon resection surgery done in Vancouver last year. I also had a tumor/polyp that was to large to remove in the colonoscopy and was biopsied as negative for cancer. The surgery was not that difficult and was done laproscopically. I did not have any pain and recovery back to my normal activities took about 10 days. Mostly I tired easily in the first week of recovery. The tumor did turn out to be early stage cancer that was not detected in the biopsy. If the tumor is too large to remove in a colonoscopy there could be some concern that the biopsy is not definitive. Laporascopic surgery is the best way to go if surgery is required as recovery time is a bit faster. It is not always possible to do it laproscopically and a regular open surgery is required. There are several factors involved that are unique to each individual. Because open is a larger cut a bit more healing time is required a more pain can be experienced. But most pain is controlled effectively with medication, so it is not necessarily worse to have open surgery as opposed to laproscopic. My research showed some advantages to open surgery such as shorter operating time and more effective examination of the colon. Detection and removal of early stage cancer (stage 1 or stage 2) is successful in curing the cancer 75 to 80% of the time depending on which study you look at. Even if the polyp is not cancer it had to come out or it may become cancer and any blockage of the colon tract has to be cleared or it will be a major problem. People's digestive tract has to function properly and have bowel movement. It is basic plumbing and surgery may be the only option. I think a colon-rectal surgeon who specializes in that surgery is mandatory and
I would not use a general surgeon unless he has lots of experience with colon surgery. I asked my surgeon and his answer was that was all he does, it is his specialty. I think he must do about 10 to 12 (maybe more) colon surgeries a week. I found him to be excellent. I don't know if North American hospitals are necessarily better than advanced modern hospitals anywhere else. I am sure that excellent hospitals and medical care exist in Asia. This is not a new cutting edge surgery and has been done for years. Laproscopic proceedures are newer, but they have been around for several years and I am sure they are being done in Asia, Europe and North America with success. Best wishes and good luck for your mother.

 
Old 04-12-2008, 12:05 AM   #7
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Re: who do colon resection

Hi Imran, (again)
If they can remove the polyp in the colonoscopy and it is not cancer that is great. A complete pathology report on the entire polyp will tell. A biopsy may not have found cancer, but that does not mean it is 100% sure because it could have missed a cancerous section. If they do find cancer in the removed polyp she will still have to have the colon resection surgery because it may have penetrated the colon wall and will spread through the lymph nodes. A pathology report will have to be done on the lymph nodes as well. The more lymph nodes that are checked the better it is. At least 12 lymph nodes should be removed and examined to ensure the tumor had not spread. A polyp or tumor that is 5cm or more is getting pretty big and can obstruct the bowel. At that point it may be too large to remove in the colonoscopy proceedure. The danger is the chance of penetrating the bowel which can cause leakage and infection in the abdominal cavity. Then they have to do emergency colon resection. The worst part of the surgery is anticipation and then being bored in the hospital for 3 or more days waiting to go home. The fear and anticipation is that it may be cancer and that it may require a colostomy bag. The bag can be permanent or temoporary. All of those negative outcomes are not ususal and your mother should not be too scared of those outcomes if she does need the surgery. Most likely it will go well and and in a few weeks she will be just fine.

 
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