This topic is about someone who had surgery for rectal cancer 2.5 years ago, which left a small part of the rectum behind. They now have a permanent colostomy and are symptom-free, managing minor issues with regular irrigation. They are considering whether to have another surgery to remove the remaining rectal stump and possibly the sphincter. Here are some insights and advice for their upcoming consultation:

- The current hospital suggests more frequent MRIs instead of surgery, as most recurrences happen within the first 2-3 years, and the benefits of removing the stump might not outweigh the risks of another major surgery.

- A second surgeon mentioned that the surgery might not be as difficult now because the high-risk areas were already addressed in the original surgery.

- Online research shows that post-operative experiences vary widely, with some people experiencing significant pain and slow wound healing, especially with a "Barbie/Ken butt" closure.

- The person is preparing for a consultation and wants to know what questions to ask and what pros and cons to consider.

Here are some points to consider:

1. Risk vs. Benefit:
- Discuss the benefits of intensified monitoring versus surgery, as the risk of recurrence decreases significantly after two years.
- Ask for specific statistics on recurrence reduction and surgical risks, and how these affect survival and quality of life.

2. Clarify Surgical Details:
- Confirm whether the surgery will involve complete perineal excision with sphincter removal or just stump excision. This decision impacts healing time, comfort, and potential nerve risks.

3. Understand Healing Expectations:
- Be aware of common complications like slow wound healing, infection, and prolonged pain, which can affect independence.
- Request a realistic timeline for recovery, including when normal activities can resume.

4. Patient Experiences:
- Some patients with retained stumps have faced concerning changes and fear difficult recoveries.
- Others have had positive experiences, with reasonable recovery times and minimal ongoing issues.

5. Practical Questions for Consultation:
- Ask about the exact surgical plan, approach, expected hospital stay, and home care needs.
- Inquire about potential nerve, sexual, or urinary dysfunction risks, especially if there was prior pelvic dissection.
- Discuss the impact of any previous radiotherapy on healing and the possibility of needing plastic surgery for closure.
- Consider seeking a second opinion from a high-volume pelvic oncology center.

6. Comfort Aids:
- Ask about pressure-relief seat cushions and support garments to aid recovery.