Colon Cancer

How Is Surgery for Colon Cancer Performed?

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.

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 colorectal cancers
• Local excision for rectal cancer
• Bowel resection and anastomosis
• Abdominoperineal excision of the rectum

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.

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.

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.

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.