Colon Cancer Surgery

Surgery remains the most important and critical form of therapy for patients with colon cancer. Tumors that involve the cecum, ascending colon, or proximal transverse colon are removed by a right hemicolectomy (see diagram below). Tumors that involve the distal half – the transverse colon, descending, or sigmoid colon are removed by a left hemicolectomy (see diagram below). It is important to not only remove the tumor itself, but a portion of the surrounding colon and adjacent blood vessels and lymph nodes. This procedure has been shown to help eliminate cancer more effectively and improve your outcome. The remaining portions of the colon are sewn or stapled together; a colostomy is rarely needed. Most patients recover normal or nearly normal bowel function within one to two weeks after a hemicolectomy.

Hemicoloectomy for the left and right colon

Newer techniques such as laparoscopic surgery are sometimes feasible in patients undergoing colon resections for cancer. They have been shown to offer the same results as traditional open surgery in terms of cancer survival and may reduce post-operative pain and shorten recovery times.

The surgical specimen is sent to a pathologist. The pathologist will provide definitive staging of your cancer by determining the size and depth of your tumor and whether the tumor has spread into any of the lymph nodes. This will help determine if any further treatment is required.

Rectal Cancer Surgery

Local or Transanal Resection: Using a special scope to see the tumor, an excision of the tumor is done with removal of a normal rim of nearby tissue. No assessment of lymph nodes is possible through this surgical route. Therefore, this procedure is reserved for very small tumors or patients who have a tumor in a very low part of the rectum and cannot tolerate a more extensive procedure.

Low Anterior Resection (LAR): Rectal tumors that are located in the middle or upper portion of the rectum are treated by this procedure. As with colon lesions, the area of tumor involving the rectum is removed with a surrounding portion of healthy rectum. The colon from above the removed area is brought down into the pelvis and connected to the remaining rectum. A temporary ileostomy often is created by taking a loop of the small intestine and sewing it to the surface of the abdomen to create an opening. Fecal matter is routed towards this opening and collected in an ileostomy bag which the patient empties. This allows the surgical area to heal without infection two to four. After an x-ray test is done to make sure the area has healed correctly, a second smaller operation closes the ileostomy. This second operation will usually be done somewhere between 2-4 months after the LAR occurs, depending on how each individual person heals. The patient then resumes normal bowel function.

Low anterior resection for rectal cancer with temporary ileostomy.

Local or Transanal Resection: Using a special scope to see the tumor, an excision of the tumor is done with removal of a normal rim of nearby tissue. No assessment of lymph nodes is possible through this surgical route. Therefore, this procedure is reserved for very small tumors or patients who have a tumor in a very low part of the rectum and cannot tolerate a more extensive procedure.

Low Anterior Resection (LAR): Rectal tumors that are located in the middle or upper portion of the rectum are treated by this procedure. As with colon lesions, the area of tumor involving the rectum is removed with a surrounding portion of healthy rectum. The colon from above the removed area is brought down into the pelvis and connected to the remaining rectum. A temporary ileostomy often is created by taking a loop of the small intestine and sewing it to the surface of the abdomen to create an opening. Fecal matter is routed towards this opening and collected in an ileostomy bag which the patient empties. This allows the surgical area to heal without infection two to four. After an x-ray test is done to make sure the area has healed correctly, a second smaller operation closes the ileostomy. This second operation will usually be done somewhere between 2-4 months after the LAR occurs, depending on how each individual person heals. The patient then resumes normal bowel function.

Abdominoperineal resection for low rectal cancer with permanent colostomy