Post-Surgery Bowel Obstruction in Rectal Cancer: What Are the Options?

Q: Post-Surgery Bowel Obstruction in Rectal Cancer: What Are the Options?

Hello： 1. <br>Colorectal cancer can be classified into stages I, II, III, and IV. <br>The term "end-stage" refers to stage IV, where the treatment outcomes are typically not 90%. <br>Generally, the success rate for a cure in stage IV colorectal cancer is less than 40%. <br>2. <br

What should be done if there is an intestinal obstruction after rectal cancer surgery?

Dear Doctor,
My father is in the terminal stage of rectal cancer.
Initially, he received radiation and chemotherapy at Kaohsiung Medical University for a period of time.
Later, the doctor informed him that surgery was necessary, but it would involve a permanent colostomy.
My father could not accept the idea of a colostomy and expressed his desire to continue with radiation and chemotherapy.
He initially considered targeted therapy, but the doctor informed him that the cure rate for targeted therapy is only 70%, while the surgery has a 90% chance of success.
Consequently, my father decided to follow the doctor's advice and underwent surgery.
After the surgery, my father became very weak and lost weight.
Less than two months after being discharged, he frequently complained of abdominal pain at home.
The frequency of the pain increased, and it became so severe that he could not eat anything.
He went a week without eating.
Eventually, he was taken back to the emergency department at Kaohsiung Medical University.
Two days later, the doctor said he could eat, but after eating, my father's abdominal pain started again.
As a result, he has been unable to eat anything since then, and his abdomen swells daily.
The nurses come every day to assist with enemas, but he has been unable to pass gas, have bowel movements, or relieve himself.
Today, the doctor told my father that he will no longer be able to eat and will have to rely on nutritional IV fluids to maintain his strength.
I would like to ask the doctor if there are no better treatment options available for my father's condition.
His current issue is abdominal swelling and intestinal obstruction, preventing him from eating.
Is there a targeted treatment method for my father's current situation?
I have received information and seen many cases of patients with advanced colorectal cancer who have had surgery and improved significantly, such as the well-known Taiwanese artist Mr.
Yang Lie, who also overcame colorectal cancer.
What should I do? I am truly worried that my father's condition will worsen.
Is there really no doctor in Taiwan who can help my father? Watching him unable to eat or drink, lying in bed, and seeing him lose weight day by day is heartbreaking, and I don't know what to do.
If this doctor cannot help, I am seeking another physician who can save my father.
I am reaching out online for assistance regarding my father's condition.
What can be done? My hope is for my father to be able to eat again and recover day by day.
I sincerely appreciate any guidance or recommendations for doctors who can treat my father's current condition.
Thank you very much.

Yifang, 20~29 year old female. Ask Date: 2007/08/17

Dr. Hou Yongji reply Surgery

Hello: 1.
Colorectal cancer can be classified into stages I, II, III, and IV.
The term "end-stage" refers to stage IV, where the treatment outcomes are typically not 90%.
Generally, the success rate for a cure in stage IV colorectal cancer is less than 40%.
2.
Kaohsiung Medical University Hospital is a medical center, and you can trust your father's physician.
However, please take the time to discuss with the physician, such as what stage the cancer is after surgery and what the future treatment plan will be.
Spending more time discussing with the physician is more beneficial than searching for information online.

Reply Date: 2007/08/17

More Info

I'm truly sorry to hear about your father's condition. Post-surgery bowel obstruction in patients with advanced rectal cancer can be a challenging and distressing situation. Let's break down the options and considerations for managing this condition.

Understanding the Situation
After surgery for rectal cancer, patients may experience complications such as bowel obstruction. This can occur due to several reasons, including adhesions (scar tissue), inflammation, or even recurrence of cancer. The symptoms you describe—abdominal pain, bloating, and inability to eat—are common indicators of bowel obstruction.

Immediate Management Options
1. Nutritional Support: Since your father is unable to eat, nutritional support through intravenous (IV) fluids and possibly total parenteral nutrition (TPN) may be necessary. This method provides essential nutrients directly into the bloodstream, bypassing the digestive system.

2. Bowel Rest: Initially, bowel rest is crucial. This means no oral intake until the obstruction is resolved. This allows the bowel to recover and may help alleviate symptoms.

3. Medications: Depending on the cause of the obstruction, medications may be prescribed to manage pain and nausea. Additionally, prokinetic agents may help stimulate bowel movement if there is a partial obstruction.

4. Enemas and Manual Disimpaction: If there is a blockage due to stool, enemas or manual disimpaction may be necessary. However, this should be done under medical supervision to avoid further complications.

5. Surgical Intervention: If conservative measures fail, surgical intervention may be required. This could involve a procedure to relieve the obstruction, such as lysis of adhesions or resection of any obstructing mass. Given your father's advanced cancer, the decision for surgery would depend on his overall health, the extent of the obstruction, and the potential benefits versus risks.

Long-Term Considerations
1. Palliative Care: Given the advanced stage of your father's cancer, palliative care should be considered. This approach focuses on relieving symptoms and improving quality of life rather than curative treatment. A palliative care team can provide support and help manage pain and other distressing symptoms.

2. Oncology Consultation: It may be beneficial to seek a second opinion from another oncologist or a specialist in gastrointestinal cancers. They can provide additional insights into treatment options, including clinical trials that may be available.

3. Supportive Therapies: Engaging in supportive therapies, such as counseling or support groups, can help both your father and your family cope with the emotional and psychological aspects of dealing with advanced cancer.

Hope and Recovery
While it is understandable to feel anxious about your father's condition, it is essential to focus on what can be done to improve his quality of life. Many patients with advanced cancer can experience periods of stability and even improvement with appropriate management.

Conclusion
I encourage you to have an open discussion with your father's healthcare team about his current condition, treatment options, and goals of care. It is crucial to ensure that he receives compassionate care tailored to his needs. Seeking a second opinion or consulting with a palliative care specialist may provide additional avenues for support and management. Remember, you are not alone in this journey, and there are resources available to help both your father and your family during this challenging time.

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