Preparing for Surgery
Your surgeon will meet with you to answer any questions you may have before your colorectal cancer procedure. You will be asked questions about your health history and a general physical exam will be performed. If your intestine requires cleaning, you will be given a prescription for a laxative medicine to take the evening before the surgery.
All patients are generally asked to provide a blood sample. Depending on your age and general health, you may also have an EKG (electrocardiogram), a chest X-ray, lung function tests, or other tests. You may also need to meet with another doctor prior to surgery.
Finally, you will meet with an anesthesiologist, who will discuss the type of pain medication (anesthesia) you will be given for surgery, and you will also learn about pain control after the operation.
The Night Before Colorectal Cancer Surgery
You will need to take the prescribed laxative medicine the evening before surgery. It is important to follow the directions carefully and take all of this medicine. This step will decrease your risk of developing an infection from bacteria normally present in the intestine.
Do not eat or drink anything by mouth after midnight the evening before surgery.
The Day of Colorectal Cancer Surgery
An intravenous (IV) tube will be inserted into a vein in your arm to deliver drugs and fluids.
Once the surgeon is ready for you, you will be taken to the operating room.
When you arrive in the operating room, the nurses will help you onto the operating table. The anesthesiologist will inject medicine into your IV that will put you to sleep. After you are asleep, the nurses will clean your abdomen with antibacterial soap and cover you with sterile drapes.
If you are having traditional "open" colon surgery, your surgeon will make an incision in your abdomen. Then they will remove the cancer and some normal colon on either side of your cancer, as well as the nearby lymph nodes.
Laparoscopic surgery is a method of surgery that is much less invasive than traditional surgery. Tiny incisions are made to create a passageway for a special instrument called a laparoscope. This thin telescope-like instrument with a miniature video camera and light source is used to transmit images to a video monitor. The surgeon watches the video screen while performing the procedure with small instruments that pass through small tubes placed in the incisions. Your surgeon will place a small needle just below your bellybutton and insert the needle into your abdominal cavity. This needle is connected to sterile tubing through which carbon dioxide is passed into the abdominal cavity. The gas lifts the abdominal wall away from the organs below to create space to give your surgeon a better view of your abdominal cavity once the laparoscope is in place.
Next, a small incision will be made near your navel. The laparoscope is placed through this incision and is connected to a video camera. The image your surgeon sees in the laparoscope is projected onto video monitors placed near the operating table.
Before starting the surgery, your surgeon will take a thorough look at your abdominal cavity to make sure that laparoscopy will be safe for you. Some reasons why laparoscopy may not be done include multiple adhesions (scars that cause organs to stick together), infection, or any spread of abdominal disease.
If your surgeon decides that laparoscopic surgery can be safely performed, additional small puncture incisions will be made for the other instruments needed to do the operation. If needed, one of these small incisions may be enlarged to enable your surgeon to remove the diseased section of intestine, or to create a connection between two ends of your intestine.
Your surgeon will begin the main intestinal surgery by closing the larger blood vessels serving the diseased section of the small or large intestine. Next, they will separate the fatty tissue that holds the intestine in place. Once the diseased section of intestine is freed from its supporting structures, it can be removed.
The procedure occasionally requires the creation of a temporary or permanent stoma (an opening of part of the intestine to the outside surface of the abdomen). The stoma acts as an artificial passageway through which stool can pass from the intestine to outside the body where it collects in an external pouch, which is attached to the stoma and must be worn at all times.
Most of the time, the surgeon will reconnect the two ends of intestines. The intestine can be rejoined in a number of ways. One method uses a stapling device that places stainless steel or titanium staples to join the ends of the intestine. The surgeon may pull the intestinal ends up through one of the small incisions and stitch the ends together. Your surgeon will choose the best method at the time of your surgery.
Finally, your surgeon will check that there are no areas of bleeding, rinse out the abdominal cavity, release the gas from the abdomen and close the small incisions.
Recovery From Colorectal Cancer Surgery
When you wake up from colorectal cancer surgery, you will be in a recovery room. You will have an oxygen mask covering your nose and mouth. This mask delivers a cool mist of oxygen that helps eliminate the remaining anesthesia from your system and soothes your throat. Your throat may be sore from the breathing tube that was present during your surgery, but this soreness usually subsides after a day or two.
Once you are more alert, the nurse may switch your oxygen delivery device to a nasal cannula (small plastic tubing that hooks over your ears and lies beneath your nose). Depending on the percentage of oxygen measured in your blood, you may need to keep the oxygen in place. The nurse will check the oxygen content of your blood by placing a soft clip on one of your fingers.
Later, you will be moved to a hospital room where nurses will measure your "intake and output." They will document all the fluids that you drink and measure and collect any urine or fluids you produce, including those from tubes or drains placed during surgery.
The tube that was passed from a nostril into your stomach (a nasogastric tube) during surgery will be removed in the recovery room. You may begin to drink liquids the morning after surgery. Once you have passed gas or have had a bowel movement, you will resume a solid diet. If you become nauseated or begin to vomit, your nasogastric tube may be reinserted.
If this happens, don't be alarmed. Nausea and vomiting are common and occur because your intestines are temporarily disabled from the surgery and the effects of anesthesia. For this reason, food and drink are given slowly for the first few days after surgery.
You will be encouraged to get out of bed starting the first day after surgery. The more you move, the less chance for complications such as pneumonia or the formation of blood clots in your leg veins.
The length of your hospital stay will depend on the type of procedure you are having and how quickly you recover. For example, the average hospital stay for a laparoscopic partial colectomy ranges from three to six days.
Recovery at Home After Surgery for Colorectal Cancer
You will be encouraged to steadily increase your activity level once you are home after surgery. Walking is great exercise! Walking will help your general recovery by strengthening your muscles, keeping your blood circulating to prevent blood clots, and helping your lungs remain clear. If you are fit and did regular exercise before surgery, you may resume exercising when you feel comfortable and your doctor gives the approval. However, strenuous exercise, heavy lifting, and abdominal exercises such as sit-ups should be avoided for six weeks after surgery.
Healthy Eating After Colon Surgery
Surgery for colorectal cancer can change the way the bowel functions, at least temporarily. Surgery can cause the bowel to become swollen and the wave-like contractions that move food along the intestinal tract (called peristalsis) may be reduced after surgery. As a result, food may not pass through the colon as quickly, causing a sense of fullness or bloating. Or, the food may not be as efficient in absorbing some of the water, causing loose stools.
You should follow a soft diet at home, which means you can eat almost everything except raw fruits and vegetables. A registered dietitian can provide more specific guidelines. You should follow this diet until your follow-up visit with your doctor. If you have problems with constipation, call your doctor.