do I really need extensive resection of colon?

[a1a]

I am a 64 yo male with no family history of colon cancer.  (But my mother had pancreas cancer and I had a melanoma 20 years ago.)  A colorectal surgeon performed a colonoscopy and found several adenomatous polyps, two of them large, situated on either side of the colon (exact size or nature not mentioned).  The surgeon recommends colonectomy in a single resection to remove portions containing the two large adenomas and the transverse colon in between, in order to also remove the transverse section where smaller polyps were found and to prevent more polyps in what therefore appears to the surgeon to be a polyp-prone portion of colon.  This is instead of two resections which would expose me potentially to more risk of complications and leave in the polyp prone transverse section.  The surgeon says I have a genetic predisposition to polyps.  The operation would remove what looks like 8-9 10ths of my colon, leaving the end connected to the small intestine and the end connected to the rectum.  The surgeon predicts that colon function would most likely return to adequate and bowel movements to normal in a few months.  The surgeon also predicts the chance of need for even a temporary colostomy to be small.  The surgeon plans a week long postsurgical stay for me in the hospital, and would expect a month long recovery to normal.  

Questions:

Is the removal of 80 to 90% of my colon more or less justified by these indications?  Is cancer likely to already to be within these large polyps?  How likely is cancer later on without this operation?

The surgeon did not say, but this sounds like "open" as opposed to lapyrotomic surgery, doesn't it?

Without a familial history of colon cancer how can genetic predisposition be a factor?  Can an acquired as opposed to an inherited genetic predisposition be what the surgeon is referring to?  

Am I am being considered at such high risk of colon cancer just because of the finding of two large adenomas and several small ones, or is some further indication being considered here to justify such an extensive resection?

Can I expect with reasonable probability to return to normal function as before, including such activity as extended backpacking trips?

How likely am I to need a temporary or permanent colostomy?

How likely are untoward after effects other than cancer (such as incontinence, infection, need for more surgery, gas, persistent vomiting, need for special diet, restriction of activity)?

Can these growths be due to TB instead?  (I worked overseas with infectious TB patients for several years, had a skin test conversion, but have had no signs of TB disease.)

Should I seek a second opinion?

[a1a]

the 3/25 one was yours to me, 3/26 is below

Thank you all. Testimony of one who went through it is especially helpful to me.

Because the two larger polyps (tubular adenomas) are at cecum and at descending colon it would take two resections to salvage the transverse stretch in between. Surgeon says that is more risky of peritoneal infection and transverse colon has polyps suggesting a future of more in that area. So take it all out he says. After looking at the surgeon's diagram with me, my son says it's more like 65% to be removed. I have been through a couple of major surgeries before, so I am not anxious, but the description of the week+ hospital aftermath and the months of recovery is particularly heartening and goes along with what surgeon said. I can't play tennis now even with a whole colon.

[Morecambe]

The most recent two sets of comments (dated 3/25 and 3/26) on this question/posting were not displayed - or could not be "clicked open".  Are you able to rectify this please?  Many thanks in anticipation.

[a1a]

Thank you all.  Testimony of one who went through it is especially helpful to me.

Because the two larger polyps (tubular adenomas) are at cecum and at descending colon it would take two resections to salvage the transverse stretch in between.  Surgeon says that is more risky of peritoneal infection and transverse colon has polyps suggesting a future of more in that area.  So take it all out he says.  After looking at the surgeon's diagram with me, my son says it's more like 65% to be removed.  I have been through a couple of major surgeries before, so I am not anxious, but the description of the week+ hospital aftermath and the months of recovery is particularly heartening and goes along with what surgeon said.  I can't play tennis now even with a whole colon.

[Morecambe]

I posted a question under my nickname "morecambe" about a year and a half ago following a total colectomy (ileorectal anastomosis) - and perhaps you can locate my inputs from the archives??  The operation was carried out following torrential rectal bleeding as a result of diverticular disease.  If you decide to undergo the operation to have 90%+ of your colon removed then perhaps I could summarise my own experience following this surgical procedure:-

- the opertaion took about four hours
- pain was well controlled afterwards via epidural pain relief
- the surgical opening/scar measured about 10 inches vertically
- you will probably be encouraged to get out of bed and move around slowly the day after the opertaion
- I was fed intravenously for about 10 days after the operation
before my intestines "reactivated themselves" (I think the condition of inactive intestines is called "ileus" or similar)
- I left hospital after 12 days but could have left earlier if the ileus had not developed.
- after returning home I took things very easy for ~2 weeks
- life was more or less back to normal (e.g started playing tennis again) after ~3-4 months
- regarding bowel movements - for the first month these were frequent (~8 per 24 hours) - the consistency was what I would call "muddy/sludgy" and yellowish in colour.
- thereafter the frequency of bowel movements gradually reduced to the present level of ~3 per day - same consistency.  Although this may seem high, it does not actually cause me any inconvenience.
- in order to avoid a sore anus following the more frequent bowel movements, I would recommend (wherever possible) washing around the anus with soapy water after a bowel movement or, after bowel emptying, gently "scrub" around the anus with toilet paper soaked in soapy water. If you are not at home, it may be useful to carry a packet of mild baby wipes in order to carry out this "cleaning process".

Although assessed for a colostomy bag prior to the opertaion, I was told that the chances of this being required were only ~2% and I was lucky...

It seems amazing that the human body can survive without a major organ such as the colon - but I can assure you that, apart from the slight increase in bowel movements and the looser consistency, life has returned to normal.

Good luck

[surgeon]

assuming reasonably normal health, the operation is not really high-risk. It's fairly common, and quite safe. As Dr. K said, the indications depend in part on the exact nature of the polyps, but to do such an operation when there are several polyps is a reasonable approach. Whereas it's likely that you'd not return to exactly the same bowel function you had pre-op, most patients get along amazingly well with only a small amount of colon; having two or three bowel movements per day without "accidents." Colostomy would be EXTREMELY unusual in this situation.

[myproblem]

This sure sounds high risk to me. I would definately seek a 2nd opinion if I were you. I would think they would just remove the polyps, and have you get colonoscopies every couple of years to monitor you.

[Kevin Pho, MD]

To answer your questions:
1) The decision to remove the entire colon would depend on the size, pathology, and location of the polyps.  The chance of cancer would depend on the histology of the polyps - some adenomatous polyps may be more prone to develop into cancer than others.

2) A colectomy can be done laparoscopically, however given the size of the excision, it is more likely an open procedure.

3) Although a family history will give a greater likelihood of cancer, one can develop cancer without a positive family history.

4) Again, the probability of the polyps developing into cancer would depend on the histology of the polpys.

5) After a colectomy, there should be no reason why a normal life can be had after the surgery.  

6) That would depend on the extent of surgery and should be discussed with your personal surgeon.

7) With any major bowel surgery there is the risk of bleeding and infection.  The chances will depend on the skill of the surgeon and how good the hospital you at in preventing infection.

8) It is unlikely that the growths are due to TB.

9) If there are continued questions about the treatment, I would always recommend another opinion.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b