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Colon Cancer

How Is Surgery Performed?

Tuesday, March 20, 2012 - 18:32

Contributing Author: Guy Slowik FRCS

The goal of surgery for colorectal cancer is to eliminate the cancer or, in the case of advanced disease, relieve symptoms.

  • With the exception of some less serious operations performed through the anus, surgery for colorectal cancer is a major operative procedure.
  • Some very early, small colorectal cancers may be removed with a colonoscope.
  • In most cases, a major operation is required and a length of the intestine is removed. But even when a large part of the intestine is removed, most people function as well as they did before the surgery.

Nice To Know:

The human body contains about 20 feet of small intestine and five feet of large intestine. Therefore, normal digestive functions are possible even if a portion of the small intestine or large intestine is removed. Most digestion of food actually occurs before the food reaches the colon.

The purpose of surgery for colorectal cancer is to achieve long-term remission. The goal is to:

  • Remove the primary cancer.
  • Leave an area around the cancerous site that is free of cancer cells. Therefore, no cancer cells are present in the tissue surrounding the surgery site.
  • Remove nearby lymph nodes. The nodes are then examined to see if they contain any cancer cells. This is important to correctly stage the cancer.

Types of colorectal cancer surgery, from the least to the most extensive surgery, are:

Colonoscopic Excision Of Early Colon Cancers

One important advance in the management of colorectal cancer over the past 30 years is the development of the colonoscope. This specialized instrument provides an accurate method for examining the colon. A colonoscope is also an important method of treatment of polyps through excision.

Polypectomy

It is possible to remove small cancers, small benign adenomas or polyps with a colonoscope. This is called a polypectomy. General anesthesia is not required. This procedure is performed on an outpatient basis.

Need To Know:

Screening tests are important. When detected early, a greater number of tumors may be removed with a colonoscope. Since this type of surgery is not as serious and involved, recovery time is shorter than with major surgery.

Local Excision For Rectal Cancer

Small superficial rectal cancers are sometimes removed by a less invasive operation than a bowel resection. The surgeon, operating through the anus, removes a disk of tissue containing the tumo. The pathologist evaluates the tissue carefully to determine the depth of invasion.

Bowel Resection And Anastomosis

This procedure involves:

  • Opening the abdomen
  • Locating the diseased area
  • Making sure it is carefully removed
  • Joining the bowel ends together with stitches
  • Closing the abdomen

During bowel resection, the surgeon removes the diseased portion of the bowel. Some tissue surrounding the diseased portion of the bowel is also removed to help make sure all the cancerous tissue is removed. Then the surgeon joins the two ends of the bowel together again, a process known as anastomosis.

Sometimes, a temporary colostomy may be performed, especially in those with rectal cancer. The surgeon may choose to create a temporary colostomy located above the anastomosis. After about three months, if tests show that the anastomosis is healed, then the colostomy opening is closed.

Abdominoperineal Resection

Abdominoperineal rection is an operation during which the entire rectum and anal canal are removed. This operation is performed when it is not possible or advisable to preserve the anal sphincter muscles or to do a local excision. With recent advances in treatment most patients do not require such radical surgery.

Abdominoperineal refers to the fact that a "double approach" is required to remove the tumor.

Colostomy

During a colostomy:

  • The doctor makes an opening in the skin to the left or right of the belly button. This opening is known as a stoma.
  • The surgeon then brings the end of the intestine through the opening and stitches it to the surface of the skin.
  • Waste materials pass through the stoma and empty into a small bag called a colostomy bag. This bag is fastened to the skin around the stoma. Colostomy bags are worn under the clothing and are not visible to others. They generally do not hamper normal activities.

This is an effective method for the temporary collection and disposal of waste material from the intestines.

Need To Know:

People fear that if they have colorectal cancer, they may need to permanently wear a colostomy bag. Because of improvements in surgical techniques for reconnecting the colon, a colostomy bag is often not needed in the treatment of most colorectal cancers.

Preparing For Colon Cancer Surgery

About a week before surgery, the doctor

  • Discusses with the patient any medications (prescription drugs as well as over-the-counter drugs) the patient normally takes.
  • Advises which medications that interfere with blood clotting must be discontinued. This includes the prescription drug Coumadin as well as over-the-counter anti-inflammatory drugs such as aspirin or ibuprofen.
  • If other medications are taken on a daily basis, the doctor will advise if these should be taken on the day of the surgery.

How-To Information:

Preparing for surgery

  • Patients are usually admitted to the hospital the day before surgery.
  • Don't eat or drink anything, not even water, at least the eight hours before surgery.
  • The evening before surgery, the bowel is cleansed using laxatives or an enema.
  • You will undergo a physical examination to check on your overall health. This includes blood tests, an electrocardiogram or EKG, urine tests, and chest x-rays.
  • An anesthesiologist visits to discuss the type of anesthetic that will be administered during surgery. Most patients receive general anesthesia so they "sleep" through the surgery.

Recovering From Surgery

The amount of time that people are hospitalized after colon surgery varies. Most people stay in the hospital several days after surgery.

During this time:

  • The intestines are inactive for several days.
  • No food is given by mouth for four to five days.
  • Intravenous infusions provide fluids to prevent dehydration or excessive fluid loss.
  • Pain medication is delivered through an intravenous line or by pump that patients control themselves, providing relief from post-operative discomfort.
  • Once the intestines resume their normal function liquid food is given for the first few days.

How-To Information

The recovery time from colon surgery ranges from tone to two months. During the recovery period, patients should

  • Avoid lifting heavy objects. Such strain may cause a herniation or a rip in the weakened muscles lining the abdominal wall. A gradually progressive exercise program, prescribed by your doctor, helps strengthen abdominal muscles.
  • Follow a high-fiber diet.
  • If excessive gas, diarrhea, or constipation becomes a problem, eliminate the suspected offending food from the diet. It may be possible to reintroduce this food later.
  • If diarrhea is a problem, eat applesauce, bananas, or rice.
  • Take laxatives or anti-diarrhea medications only when prescribed by the doctor.
  • If surgery included a colostomy, instructions on care of the colostomy will be given by specialized nurses called enterostomal therapists.

Need To Know:

Depending on the extent and stage of the cancer, additional therapies, such as radiation or chemotherapy, may be recommended after the patient has recovered from surgery. These therapies are used to destroy any remaining cancer cells. Therapies used after surgery are called adjuvant therapy.

  • If the tumor was removed at an early stage, additional therapy may not be necessary. Surgery alone can achieve long-term remission from colon cancer.
  • If the doctor suspects that cancer cells remain in the body, additional therapies are considered.
  • If lymph nodes contain cancer cells, chemotherapy, with or without radiation therapy, is usually recommended.
  • When colon cancer spreads to other areas of the body, these therapies slow the progress of the disease.

Chemotherapy and radiation may be used alone, together or in conjunction with surgery. This depends on the location of the cancer and extent of cancer spread.

  • Radiation therapy reduces the risk of the tumor recurring in the same spot.
  • Because chemotherapy affects all cells in the body, it is used to kill cancer cells both in the same spot as well as any that may have spread.
  • When radiation therapy is combined with chemotherapy, radiation therapy enhances the effects of cancer-killing drugs.

 

Colon Cancer