Immediate recovery (in hospital)

Following the ERAS protocol, postoperative recovery involves:

Early mobilization — getting out of bed within hours of surgery
Early oral feeding — clear fluids on the day of surgery, light diet from day 1
Pain control — combination of analgesics, avoiding long-term opioids
Respiratory physiotherapy — exercises to prevent pulmonary complications
Antithrombotic prophylaxis continued after discharge (usually 4 weeks)

The average hospital stay is 5-7 days for laparoscopic/robotic procedures.

Low Anterior Resection Syndrome (LARS)

What is LARS?

LARS (Low Anterior Resection Syndrome) occurs after low anterior resection and affects a significant proportion of patients. It is caused by:

Loss of the rectal reservoir — the rectum acted as a reservoir, and the new “neo-rectum” has reduced capacity
Nerve injury — pelvic nerves can be affected during surgery
Prior radiotherapy — contributes to tissue stiffening and inflammation

LARS symptoms

Defecation urgency — an imperative need to go to the toilet
Increased frequency — more bowel movements per day than before
Stool fragmentation — incomplete evacuation, requiring multiple toilet visits
Minor incontinence — small leaks of gas or fluid, especially at night
Difficulty differentiating gas from stool
Clustering — several evacuations within a short interval, followed by stool-free periods

Managing LARS

LARS gradually improves over 1-2 years, but in some patients it may persist. Management strategies (per NCCN 2025):

Loperamide (Imodium) — over-the-counter antidiarrheal that helps with clustering and incontinence
Insoluble fiber — eat foods rich in insoluble fiber and use fiber supplements. Psyllium-based products (Metamucil) can help slow and thicken stool
Adapted diet — ask your medical team for a list of foods that help or worsen LARS symptoms. An oncology dietitian can guide you
Pelvic floor exercises (Kegel) — strengthening pelvic muscles helps with urgency and incontinence
Biofeedback — anal sphincter retraining technique with a specialist
Rectal irrigation (Peristeen, Qufora) — controlled rectal washout that provides predictable periods of continence
Protective underwear — many patients find protective underwear provides peace of mind
Psychological support — adjusting to the new functional reality

Postoperative complications

Anastomotic leak

A failure of the suture (anastomosis) between the colon and the remaining rectum
Incidence: 5-15% for low anastomoses
Symptoms: fever, abdominal pain, purulent drainage
Treatment: from antibiotics and drainage to reoperation
A protective stoma reduces the severity of leak consequences

Other possible complications

Surgical wound infection
Postoperative ileus — delayed return of bowel transit
Urinary retention — difficulty urinating after surgery
Thromboembolism — preventable with prophylaxis

Side effects of chemotherapy

If you receive chemotherapy (adjuvant or neoadjuvant), it is important to know the possible side effects. Advances in supportive care have significantly improved their management.

General chemotherapy side effects

Decreased blood cell counts — can lead to anemia, bleeding, bruising and infections
Fatigue — may be prolonged
Nausea or vomiting
Diarrhea
Mouth ulcers

Drug-specific side effects

5-Fluorouracil (5-FU) — sun sensitivity (avoid sun exposure for at least one year after treatment), hand-foot syndrome (redness and pain on palms and soles). People with DPD deficiency (dihydropyrimidine dehydrogenase) may have severe reactions
Capecitabine — hand-foot syndrome (usually mild), can interact with other medications (especially folic acid, warfarin). Inform your doctor about all medications you take
Oxaliplatin — numbness of lips, hands or feet, tingling, cold sensitivity. These effects may persist after treatment ends (peripheral neuropathy)
Irinotecan — sweating, excessive tearing, abdominal cramps, diarrhea (may start the day after treatment), hair loss or thinning

Side effects of biological therapies

Cetuximab and Panitumumab — acneiform skin rash (in most patients), hypomagnesemia, allergic reactions
Bevacizumab — hypertension and proteinuria (relatively common); rarely: arterial thromboses, mucosal bleeding, gastrointestinal perforation, wound healing problems
Aflibercept — headache, fatigue, liver problems, hypertension, diarrhea
Regorafenib — hand-foot skin reaction (especially in pressure areas), skin rashes, fatigue, liver problems

Post-treatment monitoring (follow-up)

After treatment ends, regular follow-up is essential to:

Detect and prevent treatment-related side effects
Detect possible recurrence as early as possible
Provide medical and psychological support, and referrals to specialists

Monitoring schedule

Years 1-3: check-ups every 3-6 months — history, physical exam, CEA (if initially elevated)
Years 4-5: check-ups every 6-12 months
Colonoscopy at 1 year after surgery, then every 3-5 years to detect new tumors
Chest-abdomen CT every 6-12 months in the first 3 years, in patients at higher risk of recurrence

Lung metastases are more common in rectal cancer than in colon cancer. That is why chest CT monitoring is important.

If the disease comes back

If cancer recurs, treatment depends on location and prior treatment:

If radiotherapy was not given before — chemoradiotherapy is recommended, followed by salvage surgery 6-10 weeks later
If radiotherapy was already given — additional radiotherapy may be considered (external, intraoperative or local), but with limited benefit
If salvage surgery is not possible — systemic chemotherapy is recommended

Peripheral neuropathy (nerve injury)

Oxaliplatin can cause nerve injury in the fingers and feet. Symptoms include numbness, cramps, tingling or pain. Per NCCN 2025 guidelines:

Acupuncture and heat can help relieve symptoms
Duloxetine (Cymbalta) may be prescribed for persistent neuropathic pain
If pain persists, discuss with your doctor about consulting a pain management specialist

Sexual health

Many people experience sexual side effects after chemotherapy and radiotherapy:

Men — erectile difficulties (erectile dysfunction)
Women — vaginal dryness, pain during intercourse
Vaginal stenosis — pelvic radiotherapy can cause shortening and narrowing of the vagina. Vaginal dilator therapy can help. Dilators are available in different sizes and can be used after post-treatment healing

Premature menopause (in women)

Radiotherapy can affect the ovaries, causing a drop in hormones. This is called premature ovarian insufficiency and may cause: missed periods, hot flashes, sleep problems, night sweats, mood changes, vaginal dryness.

Hormone replacement therapy can ease these symptoms. Options include systemic therapy (estrogen + progesterone pills or patches) or vaginal estrogen creams/tablets for local symptoms.

Returning to normal life

Healthy habits (NCCN 2025)

Low glycemic index diet — low-GI foods may help prevent recurrence of rectal cancer
Plant-rich diet — limit red meat and processed foods. Consult an oncology dietitian
Physical activity — minimum 150 minutes of moderate exercise per week
Maintaining a healthy weight — monitor weight, diet and activity level
Reducing alcohol — alcohol consumption can increase the risk of other cancers
Quitting smoking — ask the medical team about help options (counseling, medication)
Aspirin — discuss with your doctor about the possible benefits of long-term aspirin for recurrence prevention
Screening for other cancers — follow your doctor’s recommendations for your age and sex

Emotional and financial support

Psychological support — anxiety, sleep disturbances and depression are common after treatment
Survivorship care plan — ask your oncologist for a written plan including treatment history, possible side effects and the monitoring schedule
Financial toxicity — treatment costs can become overwhelming. Speak with a social worker or patient navigator about available financial assistance
Support groups — social workers can help with rehabilitation, and patient groups offer valuable support

Recovery