Overview of Colon Cancer Surgery

Going Beyond the Polypectomy

Concentrating surgeons performing operation in operating room
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Colon cancer is treated in a variety of ways - but the foremost treatment is through bowel surgery. During your colonoscopy, the doctor can remove a portion of tissue or polyps, known as a polypectomy. However, for more advanced cancers, the doctor may need to completely remove the bowel and tissues surrounding it, which is called a bowel resection.

Why Do I Need This?

Bowel surgery allows the surgeon to completely remove the diseased portion of your colon.

Large tumors or tumors that have invaded the walls of the colon will need to be surgically removed. There are many different types of bowel surgery. Your doctor will take several factors into consideration before choosing the type of surgery that is best for you. He or she will look at your past medical history and current health, as well as the location(s), stage and grade of your cancer.

Types of Colon Cancer Surgeries

There are many different surgical approaches to removing your colon cancer. The most common surgical approach involves a long incision in the center of your abdomen, which allows the surgeon to view the entire abdominal contents, including your colon and surrounding tissues.

The laparoscopic approach, which is done with special surgical instruments through a number of tiny incisions in your abdomen, is also being used to remove some colon cancers. Depending on the location and extent of your cancer, the surgeon may complete a:

  • Segmental resection
  • Radical resection or colectomy (right, left, sigmoid, total)
  • Partial colectomy or hemicolectomy
  • Local excision
  • Proctectomy
  • Colostomy and ileostomy

Rectal Cancer Surgeries

  • Low anterior resection (LAR)
  • Transanal excision
  • Abdominoperineal resection (APR)
  • Anterior resection with anastomosis and proximal diversion
  • Proctectomy

Despite all the fancy names, there are really only a few key terms you need to remember about your bowel surgery:

Colectomy - removal of a portion of the colon (also called a resection). The specific colectomy you will have is named by which portion (or portions) of the colon is removed. For instance, a transverse colectomy involves removing the transverse colon. A right hemicolectomy (half) involves removing the right portion of the colon. A radical total colectomy involves removing the entire colon.

Anastomosis - sewing portions of the colon back together after a diseased piece has been removed. If the surgeon removes the transverse colon, he or she may sew the ends of the ascending and descending colon back together.

Stoma - an artificial opening made in the skin, such as a colostomy or ileostomy. If you have had the entire colon removed or if the surgeon cannot reattach two portions of colon together (until they have healed), he or she will make an opening in your stomach wall for passage of stool into a bag.

There are reversible and non-reversible stomas, depending on the extent of your surgery.

Preparing for Surgery

Prior to any surgery on the colon, it must be squeaky clean on the inside. This is accomplished through a complete bowel preparation, similar to the one you may have had for your colonoscopy. This preparation reduces the risk of infection during your bowel surgery. Unlike your colonoscopy prep, however, your doctor may place you on preventive antibiotics before surgery, also to decrease your risk of post-operative infections.

Questions for the Surgeon

  • What is the operation called?
  • Will I need a colostomy or an ileostomy? If yes, for how long?
  • Will I need chemotherapy or radiation? Before or after surgery?
  • What are my alternatives to surgery?
  • How long will I be in the hospital?
  • When can I return to work? Normal activities?
  • Will I need to stop taking my prescription medications? Before surgery, notify your doctor about all prescription and over-the-counter medications, as well as any nutritional supplements you are taking, especially if you are on aspirin or blood thinners.

Risks of Bowel Surgery

Every medical procedure carries risks and benefits. Make sure you talk to your doctor and ask questions if you do not understand these risks. Some of the risks associated with bowel surgery include:

  • Bleeding
  • Infection
  • Leaking anastomosis
  • Blood clots (usually in the legs)
  • Incision dehiscence (opening of the abdominal incision)
  • Scarring
  • Adhesions
  • Sexual dysfunction (reported in men following the APR and proctectomy)

The most commonly reported side effect statistically was sexual dysfunction in men, reported by between 10 to 50 percent of the patients after surgery. However, take note that these statistics do not account for their libido, age or treatment modalities prior to surgery.

Leakage from the anastomosis site occurs in one to three percent of patients with an anastomosis including the small intestine and between 10 to 20 percent of patients with a colon and anal anastomosis.

Post-surgical infections are reported in five to 15 percent of patients, although specific factors (age, weakened immune systems, malnutrition) play a huge role in your risk for post-operative infection.

Recovering from Bowel Surgery

You will be required to stay in the hospital for at least a few days following your bowel resection. Your time in the hospital will allow your surgical incisions to begin healing while trained nurses and doctors monitor your hydration, nutrition, and other needs after surgery.

Your doctor will have orders in place to treat any post-operative pain. Pain medications may be given intravenously, intramuscularly or by mouth. When your pain first begins, be sure to report it to the nurse on duty so he or she can treat it immediately, not after it escalates.

Depending on your surgery, you may have drains in place. These drains allow excess fluids, such as blood, to leave your abdomen. The drains may be removed before your discharge from the hospital. If you had a colostomy or ileostomy inserted during the surgery, the nursing staff will teach you how to care for your appliance before you go home.

Your surgeon will plan your nutritional needs for you following surgery. You may need a special diet while your bowel is healing. Until your bowels "wake up", the doctor may keep you on a clear liquid diet (non-solids, anything you can see through). You will be given dietary instructions before you go home.

When to Call Your Doctor

Following any major surgery, the main concerns are blood loss, infection, and other complications. Listen to your body; report any unusual symptoms to your surgeon. Call your doctor immediately if you have:

  • Fever
  • Increasing pain
  • Redness, drainage or tenderness around incisions
  • Non-healing areas of incision
  • Nausea, vomiting
  • Blood in the stool or colostomy bag
  • Cough that does not go away
  • Yellow eyes or skin

Life After Surgery

You may be discharged from the hospital with an overwhelming amount of instructions. Do not hesitate to ask friends and family for help and support. Give your body the time it needs to heal. Dietary and activity recommendations will allow your colon time to heal. Your doctor and nurses are there to answer your questions, so don’t hesitate to ask if you don’t know the answer.

Sources:

American Cancer Society. (2006). American Cancer Society’s Complete Guide to Colorectal Cancer. Clifton Fields, NE: American Cancer Society.

American Cancer Society. (n.d.). Surgery for Colorectal Cancer. Accessed February 12, 2012.

Dietz, D.W. (2011). Complications in Colorectal Surgery. American Society of Colon and Rectal Surgeons. Accessed February 26, 2012.

National Cancer Institute. (n.d.). Colon Cancer Treatment: Treatment Overview. Accessed February 13, 2012.

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