Colon cancer surgery, also called colorectal cancer surgery, is a surgical procedure used to treat cancer of the large intestine. Surgery is most often performed for early-stage colorectal cancers, and offers the best chance at a cure. There are several surgeries that may be used for colon cancer, depending on the location, stage and grade of the cancer as well as on the patient’s overall health and preferences.
These surgical options include:
- Partial colectomy: In this surgery, the surgeon removes part of the colon, and joins the remaining parts in a procedure called anastomosis. Patients undergoing this operation should see their bowel habits go back to normal.
- Right colectomy: The right side of the colon is removed.
- Ileocolectomy: The ileum, or the last segment of the small intestine, which is attached to the right side of the colon, is removed along with the right side of the colon.
- Abdominoperineal resection: The anus, rectum and sigmoid colon are all removed, and the patient will require a permanent colostomy, in which the end of the colon is brought through the abdominal wall and then stitched to the skin of the abdominal wall to form an opening called a stoma. Stool then drains from the stoma into a bag or pouch attached to the abdomen.
- Procstosigmoidectomy: This diseased part of the rectum and sigmoid colon is removed.
- Total abdominal colectomy: The entire large intestine is removed.
- Total proctocolectomy: This is the most extensive bowel operation. The surgeon will remove both the rectum and the colon. If possible, the surgeon will try to leave the anus intact; if it works, he or she may be able to create an ileal pouch, which will enable patients to use the bathroom normally. However, if the anus must be removed or is weak or damaged, a permanent ileostomy may be required.
There different types of surgery that can be performed as well. For instance, surgeries performed through an incision in the abdomen include an open colectomy (also called a hemocolectomy, partial colectomy or segmental resection), and permanent or temporary ileostomy or colostomy. This traditional form of surgery has side effects such as pain that requires medications for two to three days, and patients will receive nourishment through IV fluids.
Laparoscopic surgery is a newer approach to removing the colon and nearby lymph nodes, and may be a better option for some patients with early-stage cancers. Here, the surgeon makes several smaller abdominal incisions instead of one large one, and special long instruments are inserted through the incisions to remove the affected part of the colon and lymph nodes. Patients with this type of operation may recover slightly more quickly and have less pain than they would with open surgery.
Finally, for very early cancers (stage 0 and stage I tumors) and polyps, surgery to remove these growths can be done without any incisions at all, but rather through the use of a colonscope during a colonoscopy. In a polypectomy, the cancer is removed as part of the polyp, which is cut at its stalk. In a local excision, superficial cancers and a small amount of nearby tissue are removed.
Following many kinds of colon cancer surgery in which the colon and other parts of the digestive system are removed, doctors have to create a way for the patient to release waste from the body. This is accomplished through fecal diversion, meaning the creation of an ileostomy or colostomy. These ostomies are surgical openings in the skin that allow waste to leave from the intestines (an ileostomy or colostomy) or bladder (urostomy). A continent ileostomy, referred to as a K-pouch, is a connection of the end of the small intestine to the abdominal skin. This has a valve created by sewing the intestine in a manner that stops the waste from leaking out. Instead, a catheter is inserted to empty the pouch. Ileoanal anastomosis surgery, referred to as a J-pouch, allows patients to remove waste normally even after the removal of the colon and rectum, thus avoiding the need for a stoma to facilitate bowel movements. The J-pouch is formed from the end of the small intestine and is attached to the anal canal to form a pathway for the passage of stool.