Surgery for Colon Cancer

Of the treatments available for colon cancer, surgery is the most commonly prescribed as it enables effective and immediate removal of cancerous tissue. However, the effectiveness of surgery also depends largely on the extent of the cancer, that is, the stage the cancer is at.

If you’ve been diagnosed with colon cancer, what are the surgeries likely to be recommended to you, and what do you need to know before proceeding?

Prior to some colon surgeries, bowel preparation is required to ensure that surgeons have a clean and empty bowel to operate on. Your physician may prescribe you a special diet, laxative drinks or enemas to remove all the stool in your colon.

For cancers with larger tumors or more advanced but localized growth, doctors may also prescribe neoadjuvant treatment such as chemotherapy or radiation therapy to reduce the size of the tumor before surgery. The pre-surgery treatment also helps to reduce the rate of cancer recurrence at the site of operation.

Surgeries to remove tumors from the colon can sometimes be done during a screening or diagnostic colonoscopy. Otherwise, a separate surgical procedure is arranged.

During a colonoscopy, tools can be inserted through the colonoscope to remove any tumors or tissue. While this is considered a surgical procedure and is billed as such, colonoscope to remove any tumors or tissue. While this is considered a surgical procedure and is billed as such, the procedure is completed from inside the colon and does not require any incisions made from outside the abdomen. You will also be sedated during the procedure.

Tumors in the colon often form from polyps, and polypectomy refers to the procedure of removing a polyp or parts of it by cutting at the base or “stalk” (such as in the case of pedunculated polyps) on the intestinal lining. To do so, a wire loop is passed through the colonoscope and the polyp is cut from the intestinal wall using an electric current. A polypectomy is considered a minor surgery and is minimally invasive compared to major surgery.

Unlike surgeries done during a colonoscopy, other surgeries to treat colon cancer are considered major and require general anesthesia to ensure that you are asleep and the procedure is pain-free. Open surgery on the colon would be done through a long, vertical incision made on your belly.

Depending on the cancer’s spread, it may be essential to remove your entire colon or a part of it. This procedure is called a colectomy, and includes removal of the rectum in the case of rectal cancer.

Partial colectomy: Removal of part of the colon but not the rectum

Subtotal colectomy: Removal of the entire colon but not the rectum

Proctocolectomy: Removal of the entire colon and rectum

Proctectomy: Removal of the entire rectum but not the colon

After part of the colon is removed, anastomosis is done on the remaining healthy ends of the colon to join them together by stitching or stapling. This can occur at different parts of the colon depending on the portion removed.

Right hemicolectomy: The ascending colon and a portion of the transverse colon are removed, and the transverse colon is connected to the end of the small intestine known as the ileum.

Sigmoid colectomy: The affected part of the sigmoid colon is removed and the descending colon is connected to the rectum.

Left hemicolectomy: The descending colon, along with part of the transverse colon and the sigmoid colon is removed. The transverse colon is connected to the rectum, however, surgeons are likely to create a temporary ostomy as the risk of infection is high for left hemicolectomy.

If resection is not possible, such as in the case of a complete removal of the colon, removal of the rectum, or not enough healthy colon left, the surgeon will do a colostomy and create a hole or stoma in your abdomen. The healthy end of your small or large intestine is then attached to the stoma, and a bag is worn over the hole to collect stool and waste matter. Sometimes, a colostomy may be done as a temporary measure to give your colon time to recover after the surgery.

Surgery on the colon can also be done laparoscopically by making small cuts on the abdomen. Special tools, including a laparoscope (a long, thin and rigid tube with a light and a camera on the end) are inserted through the incisions to allow the surgeon to see inside the abdomen. Laparoscopic-assisted colectomy can sometimes also be robot-assisted — the surgeon uses a console to control robotic arms that move the surgical instruments.

For surgeries that require anesthetic, it may take longer for you to regain bowel function. This condition, known as an ileus, means that you may not be able to tolerate any oral intake. This condition usually resolves itself over time and is a normal physiologic response of the intestine to the surgery. In such cases, your doctor may recommend delaying any food or liquid intake.

Separately, surgeries carry a risk of bleeding and infection at the site of operation, as well as blood clots in the legs. Pain is also an expected side effect, and these can be managed with the help of medication.