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Long-haul flights need clearance."},"follow_up_visits":[{"purpose":"wound_check","requirement":"routine","after":{"min":10,"max":21,"unit":"days","qualifier":"First postoperative review after surgery; often done remotely."}},{"purpose":"result_review","requirement":"routine","after":{"min":14,"max":42,"unit":"days","qualifier":"Review of histopathology and decision on further oncological treatment, if the indication was cancer."}},{"purpose":"assessment","requirement":"routine","after":{"min":60,"max":120,"unit":"days","qualifier":"Functional and recovery assessment; later surveillance depends on diagnosis."}}],"indications":["Rectal cancer, particularly when resectable","Large rectal polyps or tumors not suitable for endoscopic removal","Rectal prolapse (in selected patients)","Selected inflammatory bowel or diverticular disease involving rectum or rectosigmoid","Severe radiation injury, stricture or fistula in selected cases"],"main_risks":["Anastomotic leak","Infection (wound, pelvic abscess)","Bleeding","Bowel dysfunction (low anterior resection syndrome)","Urinary and sexual dysfunction from pelvic nerve injury","Temporary or permanent stoma","Venous thromboembolism","Postoperative ileus or bowel obstruction","Incisional hernia","Adhesions and anesthesia-related risks"],"pain":"Moderate to significant pain in the first days, managed with multimodal analgesia (often epidural or regional blocks plus oral medication); typically settles over 1–3 weeks.","preparation":["Preoperative staging and fitness assessment (imaging, colonoscopy, labs, anesthetic review)","Multidisciplinary team discussion when cancer is the indication","Stoma counselling and site marking","Bowel preparation and fasting before surgery","Smoking cessation and nutrition optimization","Individual instructions on regular medications from surgical team"],"recovery_timeline":[{"phase":"Hospital stay (days 0–7)","description":"Early mobilization, gradual diet resumption, pain control, return of bowel function, stoma teaching if present.","restrictions":["No heavy lifting","Follow staged diet advice"]},{"phase":"Early home recovery (weeks 1–4)","description":"Increasing walking, fatigue gradually improving, bowel habits adjusting. Report fever, wound problems or worsening abdominal pain promptly.","restrictions":["Avoid heavy lifting and straining"]},{"phase":"Return to work and normal activity (weeks 4–12)","description":"Gradual return to work and exercise; bowel function continues to adapt.","restrictions":["No heavy lifting until surgeon clearance","Strenuous exercise only after surgeon clearance"]}],"rehabilitation_days":{"min":28,"max":60,"unit":"days","qualifier":"Ordinary functional recovery for daily activities after uncomplicated resection; full bowel-function adaptation takes longer."},"result_longevity":"Removal of the diseased rectum is permanent. Long-term outcome depends on diagnosis and stage; for cancer, oncological surveillance continues for about 5 years. Bowel function usually stabilizes within 3-12 months.","revision_rate_pct":{"min":5,"max":15,"unit":"percent","qualifier":"Unplanned reoperation within 30-90 days, mainly for anastomotic leak, bleeding or obstruction; excludes planned stoma reversal."},"scars":"Several small port scars with laparoscopic or robotic approach plus a small extraction incision; a longer midline incision with open surgery; a stoma site if a stoma is created.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single operation for uncomplicated resection with primary anastomosis."},"stages":[{"code":"resection","label":"Rectal resection with reconstruction (anastomosis) or end stoma","after":{"min":0,"max":0,"unit":"days","qualifier":"Day of surgery."}}],"qualifier":"Staged stoma reversal or neoadjuvant therapy are separate treatments and not included."},"success":{"metric":"Local recurrence-free survival after curative rectal cancer resection","value":95,"unit":"percent","horizon":"5 years","population":"Adults with resectable stage I-III rectal cancer undergoing total mesorectal excision","evidence_status":"limited"},"techniques":[{"name":"Anterior resection (high or low) with total or partial mesorectal excision","suits_whom":"Most rectal tumors where the sphincter can be preserved","recovery":"Hospital stay about 4–7 days; possible temporary diverting stoma."},{"name":"Abdominoperineal resection","suits_whom":"Very low tumors involving the sphincter complex","recovery":"Permanent end colostomy; perineal wound healing may extend recovery."},{"name":"Laparoscopic or robotic approach","suits_whom":"Selected patients with suitable anatomy and surgeon expertise","recovery":"Often shorter hospital stay and quicker early recovery than open surgery."},{"name":"Open resection","suits_whom":"Complex, bulky or previously operated cases","recovery":"Longer incision and typically somewhat longer recovery."}],"treatment_conditions":["inpatient"],"treatment_duration_hours":{"min":3,"max":6,"unit":"hours","qualifier":"Operating time for uncomplicated elective rectal resection; varies with approach and complexity."},"initial_assessment_documents":["Colonoscopy report with biopsy histology","Pelvic MRI report and images","CT chest and abdomen report","CEA blood test result","Recent blood tests and ECG","Previous abdominal surgery operative reports (if available)"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Single operation; stay 7-14 days including hospital stay and discharge clearance. Follow-up usually done at home; stoma reversal is separate."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Understand the possible complications and side effects of the treatment before booking","scope":"treatment_type","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Make sure you understand the possible complications and side effects that could arise from your treatment.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C2","text":"Get a second opinion from a doctor before deciding on the treatment","scope":"treatment_type","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"A doctor can give you a valuable second opinion as well as advice about treatment options and whether it's 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treated","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Are you satisfied with the facilities and standards at the clinic or hospital where you'll be treated?","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C6","text":"Confirm how your aftercare will be coordinated","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Ensure you're clear about how your aftercare will be coordinated.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"A hard sell for treatment abroad is a warning 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sign","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"a hard sell a lack of information pressure to make a quick decision no discussion of possible complications no mention of aftercare","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F4","text":"No discussion of possible complications is a warning sign","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"a hard sell a lack of information pressure to make a quick decision no discussion of possible complications no mention of 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