Transcript of video
When colostomy is a better alternative after rectal caner surgery? When permanent colostomy can be avoided? What is quality of anorectal function after radical surgery for rectal cancer? What is LARS (Low Anterior Resection Syndrome)? Rectal cancer colostomy alternatives? Permanent colostomy or not? Anorectal function after rectal cancer surgery. Dr. Anton Titov, MD. Rectal cancer treatment. Leading Swedish rectal cancer surgeon discusses rectal cancer treatment nuances. Advanced rectal cancer surgery. Medical second opinion confirms that rectal cancer diagnosis is correct and complete. Medical second opinion also confirms that rectal cancer surgery is required. Best treatment for rectal cancer. Dr. Anton Titov, MD. Medical second opinion helps to choose the best treatment for rectal cancer. Get medical second opinion on rectal cancer and be confident that your treatment is the best. Best rectal cancer treatment center and cancer surgeon. Video interview with leading expert in rectal cancer treatment surgery and minimally invasive rectal cancer treatment. Rectal cancer colostomy alternatives? Colostomy or not? Anorectal function after rectal cancer treatment. Dr. Anton Titov, MD. Preserving anorectal function in colorectal cancer patients after surgery is very important. Stoma is not always needed. Anorectal function or need for stoma is a significant factor in quality of life for colorectal cancer patients. Surgical operation for colorectal cancer affects anorectal function. The type of surgical operation that rectal cancer patient has affects anorectal function or need for colostomy. Also radiation therapy side effects and potential complications from radiotherapy for colorectal cancer treatment affect anorectal function or colostomy requirement. Dr. Anton Titov, MD. How do you select the type of treatment for rectal cancer patients with the goal of preserving anorectal function after the treatment? When colostomy is required in rectal cancer? Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). Need for colostomy after rectal cancer treatment is a very good question. It is a very very difficult question. Because the primary goal in the treatment of colorectal cancer is to cure the patient. So that’s the primary goal. It is to cure the patient. Sometimes you need to give radiotherapy and chemotherapy to colorectal cancer patients to increase the chance of cure from rectal cancer. Again, if you think you don’t need radiotherapy or chemotherapy for rectal cancer. Sometimes you think you can do a good total mesorectal excision surgical operation without radiation therapy or chemotherapy. Then you should do it because you reduce the postoperative morbidity. You reduce complication rate and side effects of multimodality treatment of colorectal cancer. But if you have to use radiotherapy and chemotherapy in colorectal cancer treatment, you should use it. Then you have to inform the colorectal cancer patient about this. A combination of total mesorectal excision surgery with low anterior resection and anastomosis and radiotherapy with chemotherapy will result in a poor anorectal function. It may require a permanent stoma. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). There are no patients who had TME surgical operation and chemotherapy with radiotherapy who have good anorectal function after colorectal cancer treatment. All patients have some impaired anorectal function. This has been studied very thoroughly. Dr. Anton Titov, MD. Recently there is a clinical trial on anorectal function after colorectal surgery from Denmark. They have invented the low anterior resection syndrome system (LARS system). They have developed scoring system for quality of anorectal function after colorectal cancer multimodality treatment. You score the anorectal function in a rectal cancer patient after treatment. It is then obvious that the majority of patients have quite poor anorectal function. But on the other hand it’s very difficult to keep good anorectal function without colostomy after extensive rectal cancer treatment. Extensive cancer therapy includes surgical operation, radiation therapy, and chemotherapy. That’s why it is so important to inform the patient. Because you inform the patient about likelihood of poor anorectal function after rectal cancer treatment. Some patients may actually prefer to have the permanent colostomy placement, the stoma. Colostomy in many situations is easier to treat than this LARS (Low Anterior Resection Syndrome). When patient is without colostomy, patient has to go to the toilet very often. Patients without stoma have to obviously need to be aware everywhere whether the toilets are. Maybe patients without stoma after rectal cancer treatment cannot go to the theater or to a dinner. Because you know suddenly you have to go to the toilet very quickly. Sometimes cancer surgeon informs the patient about this situation. Some patients, at least in Sweden, actually prefer to have a permanent stoma after rectal cancer treatment. It is better to have permanent colostomy than to have poor anorectal function. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). So it is extremely important to tailor radiation therapy and chemotherapy and surgery for individual rectal cancer patient. Don’t use chemotherapy and radiotherapy if you don’t need it. But unfortunately most patients with rectal cancer will need both surgery and radiation therapy and chemotherapy. Anorectal function after such multimodality rectal cancer treatment will not be perfect. That’s just the way it is. Sometimes it’s better to have permanent colostomy placement. It is not good to have a bad anorectal function after rectal cancer treatment. But the information of patients about stoma or no stoma options is crucially important. Dr. Anton Titov, MD. Rectal cancer colostomy alternatives? Are you better with permanent ostomy after rectal cancer surgery? How good is anorectal function in low anastomosis?