Colorectal Cancer Surgery

Colorectal cancer affects about 140,000 people every year, making it the third most common cancer in both men and women. Colorectal cancer is most often treated with surgery to remove the tumor and, possibly, chemotherapy and radiation.

Colorectal Cancer Surgery Terms

  • Polypectomy is a procedure in which polyps -- small growths on the inner lining of your colon -- are removed. It happens during a colonoscopy, which is when your doctor puts a special instrument (called a colonoscope) into your bottom to look at the rectum and colon.
  • Local excision can treat cancers in the rectum (the lowest portion of the colon). It involves removing the cancer and some of the wall of the rectum. Your doctor may do it through the anus (the opening of the rectum) or through a small cut in the rectum. The procedure does not require major surgery.
  • Resection involves the removal of part or all of the colon along with the cancer and nearby tissues.
  • Laparoscopic surgery. The word "laparoscopy" means to look inside your abdominal cavity with a special camera or scope. Your doctor makes 3 to 6 small (5- to 10-millimeter) cuts in your belly. They insert the laparoscope and special laparoscopic instruments. The laparoscope sends a picture of your organs to a video monitor so the doctor can see how to do the procedure.

What Is Laparoscopic Surgery?

Bowel and intestinal surgeries used to be done through long cuts in the belly, which often meant a long, painful recovery. In the early 1990s, doctors started using a laparoscope, an instrument that had mostly been used to treat gynecological problems and gallbladder disease, to do certain types of bowel surgery. Laparoscopic surgery needs only small cuts. A type of laparoscopic surgery called hand-assisted lets a doctor put their hands into the patient’s belly while seeing the procedure with the laparoscope.

A laparoscopic approach usually has less pain and scarring, a faster recovery, and less risk of infection than an open surgery through a large cut.

Colorectal surgeons have used laparoscopy to treat these conditions:

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Surgery Options for Colorectal Cancer

Several types of surgery may be used to treat colorectal cancer:

  • Partial colectomy. This is also known as a hemicolectomy or segmental resection. The surgeon removes part of your colon and some nearby lymph nodes. The remaining parts are joined in a procedure called anastomosis. Afterward, your bowel habits should be similar to the way they were before cancer. If you have a laparoscopic procedure, you may leave the hospital faster than you would with traditional surgery. But it will require special expertise. Survival rates are about the same either way.
  • Right colectomy or Ileocolectomy. During a right colectomy, the doctor takes out the right side of your colon. During an ileocolectomy, the last segment of the small intestine -- which is attached to the right side of the colon, called the ileum -- is also removed.
  • Abdominoperineal resection. Your anus, rectum, and sigmoid colon are removed. You’ll need a permanent colostomy afterward.
  • Proctosigmoidectomy. The diseased section of the rectum and sigmoid colon is removed.
  • Total abdominal colectomy. Your entire colon is removed. Doctors rarely do it for cancer. It’s usually done to treat conditions like inflammatory bowel disease.
  • Total proctocolectomy. This is the most extensive kind of bowel operation and involves the removal of both the rectum and the colon. If the surgeon can leave the anus and it works the way it should, they may make an ileal pouch (see below) so you can go to the bathroom as you did before you had cancer. But often, a permanent ileostomy (see below) is needed, especially if the anus must be removed, is weak, or has been damaged.

Other Procedures for Colorectal Cancer

  • Stomas or ostomies. A stoma is an opening of some part of the bowel onto the skin. A colostomy is when the end of your colon is connected to a stoma, and an ileostomy is when the stoma is attached to the end of the small intestine. Your stoma may be permanent if waste can’t go through its normal route after surgery. Temporary stomas keep stool away from a damaged or recently operated area while you heal. The waste that comes out of a stoma is collected in a bag.
  • Fecal diversion. This procedure makes an ileostomy or colostomy. It’s often a temporary measure to allow healing of an infection, surgery, or long-term inflammation.
  • Ileal (J) pouch. To replace your rectum and provide a place to store waste before going to the bathroom after a total proctocolectomy, your doctor may make a pouch out of the end of the small intestine, called the ileum. There are different forms, named after the shape that your doctor puts the small intestine in before sewing or stapling it to make a pouch. The most common form is the "J" pouch. This is a complicated procedure, and it doesn’t always work. To improve your chances, your doctor will make a temporary ileostomy so the pouch won’t have to handle waste while it heals. A temporary ileostomy can usually be reversed after about 2 to 3 months.
  • K pouch. This is also known as a "continent ileostomy." Unlike a usual ileostomy, which is attached to a bag outside your body, the K pouch provides a holding area for waste and adds a nipple valve to keep it from leaking. You empty the pouch by inserting a stiff catheter through the stoma. This type of pouch isn’t very popular among surgeons because the valve often comes undone or slips, leading to another operation to repair it. The surgery is very complex, and long-term problems are common.
  • Liver surgery. In between 60% and 70% of colon cancer cases, the cancer spreads to the liver. Depending on how far your cancer has spread, you could have those tumors removed at the same time as your colon surgery. This can be combined with chemotherapy, and it can lessen complications and shorten recovery time.

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Recovery

Most people who have colon cancer surgery recover well. For the first few days, you’ll need to take pain medicines. You may not be able to eat, or you may get only liquids. But you’ll be able to eat solid food soon after.

Colon cancer surgery does carry risks, including bleeding, infection, and blood clots in the legs.

Rarely, the places where your colon is rejoined may leak. This can lead to infection and more surgery. Symptoms of a leak include:

  • Severe belly pain
  • Fever
  • A hard belly

In milder cases, the leak could lessen your appetite or make recovery take longer.

Scar tissue could form inside your belly. This could make your organs and tissues stick together or make your intestines twist so your bowel is blocked. If that happens, you’ll have some pain and swelling. You may need to have more surgery.

Follow-up

Keep in touch with your care team after surgery.

With advanced cancer, the goal of surgery is often to help with symptoms more than it is to cure the condition. In many cases, your doctor will recommend other treatments, like chemo, in addition to surgery.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on August 05, 2019

Sources

SOURCES:

American Cancer Society.

National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.

American Cancer Society: “Surgery for Colon Cancer.”

Memorial Sloan Kettering Cancer Center: “Colon Surgery,” “Metastatic Colon Cancer,” “Surgery for Liver Metastases.”

Cancer.net: “Follow-up Care for Colorectal Cancer.”

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