- What is colorectal cancer?
- Cancer screening
- Risk factors
- Treatment
- Surgery
- Chemotherapy
- Radiation therapy
- Immunotherapy
- Targeted therapy
- Early-onset colorectal cancer
- Liver directed therapy
Colorectal Cancer Surgery
The primary goal of surgery for colorectal cancer is to remove the cancer from the body.
Surgery can be the only treatment in cases of early stage colorectal cancer or it can be combined with chemotherapy, radiation therapy, targeted therapy, or immunotherapy to treat some early stage and most advanced stage CRC. Surgery can be performed as the first treatment, or it can come after an initial treatment with chemotherapy and/or radiation.
How is colorectal cancer surgery performed?
The surgical procedure, including what is removed and how the colon and rectum are repaired, varies based on cancer stage and tumor location. The type of surgery, either minimally invasive or open surgery, can also be different based on stage and location.
There are several ways to get to the colon and rectum to remove colon cancer and rectal cancer. This can be done with minimally invasive or invasive techniques. Minimally invasive surgeries include endoscopy (colonoscopy), laparoscopy, and robotic surgery. These methods involve either no external incision (endoscopy), or several small incisions in the abdomen (laparoscopic or robotic surgery). The invasive technique for CRC is open surgery, sometimes called laparotomy, requiring a larger abdominal incision.
How is endoscopic colorectal surgery or colonoscopy performed?
Endoscopic procedures are performed by inserting a long tube through the anus into the rectum and colon. The tube, called an endoscope or colonoscope, has a light and a camera at the end, so that the endoscopist can see inside the colon and rectum. The surgeon can also pass small surgical instruments through the tube to perform polypectomy, endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD). Minimally invasive endoscopic procedures for colorectal cancer may be done by a gastroenterologist, a general surgeon, a colorectal surgeon, or a surgical oncologist.
How is laparoscopy or laparoscopic surgery performed?
Laparoscopic colorectal cancer surgery is done with 3-5 small abdominal incisions, each 1-1.5 cm (0.4-0.6 inches) long. A thin tube (trocar) is placed in each incision, and the abdominal cavity is filled with carbon dioxide gas to make room for the surgeon to see and work in the area. The surgeon puts a camera through one of the trocars and uses the other trocars to place and operate specialized surgical instruments. Many colon cancer or rectal cancer surgeries will require an additional incision, about 5-10 cm (2-4 inches) long, to get the resected piece of colon or rectum out of the abdomen. Most surgeries for CRC can be done laparoscopically. Sometimes called keyhole surgery, laparoscopic surgery for colorectal cancer is performed by a specially trained general surgeon, colorectal surgeon or surgical oncologist.
How is robotic surgery performed?
Robotic surgery, also called robot-assisted surgery, is a very specialized minimally invasive technique. Like laparoscopy, surgery is performed through trocars with cameras for visualization. However, the instruments are not controlled by the surgeon's hands directly. The surgeon controls robotic arms through a computer, and the robotic arms move the surgical instruments. Robotic surgeries are performed by a specially trained general surgeon, colorectal surgeon, or surgical oncologist.
How is open surgery or laparotomy performed?
Open surgery for colorectal cancer is performed through a single long incision in the abdomen. It is performed by a general surgeon, a colorectal surgeon, or a surgical oncologist.
What type of surgery will I have for colorectal cancer?
Surgical procedure | Cancer stage | Tumor location | What is it? |
|---|---|---|---|
| Polypectomy | Stage 0 or early stage I | Colon or rectum | Removal of a colorectal polyp |
| Local excision | Stage 0 or stage I | Colon or rectum | Removal of tumor including a margin of healthy tissue |
| Local excision by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) | Stage I or stage II | Colon or rectum | Removal of tumor including a margin of healthy tissue |
| Local excision by transanal endoscopic microsurgery (TEM) | Stage 0 or early stage I | Rectum | Removal of tumor including a margin of healthy tissue |
| Partial colectomy, also known as segmental resection or hemicolectomy | Stage I, Stage II, Stage III, | Colon | Removal of the part of the colon containing the tumor including a margin of healthy tissue. The two healthy segments of colon are reconnected via anastomosis. |
| Total colectomy (usually used only in cases with hundreds of colon polyps or other colon disease) | Any stage | Colon | Removal of the whole colon. The end of the small intestine (ileum) may be connected to the rectum to restore bowel continuity and bowel function. |
| Low anterior resection | Any stage | Rectum (upper part) | Removal of the upper part of the rectum. |
| Abdominoperineal resection | Any stage | Rectum (lower part) | Removal of the lower part of the rectum. |
| Proctectomy | Any stage | Rectum | Removal of the whole rectum. |
| Total proctocolectomy | Any stage | Colon and rectum | Removal of the whole colon and rectum. The end of the small intestine may be connected to the anus (ileoanal anastomosis), with the addition of an ileal pouch, to restore bowel continuity and bowel function. |
| Lymph node dissection | Any stage | Colon or rectum | Removal of lymph nodes near the tumor. Nearby lymph nodes are examined under a microscope to look for cancer cells that may have spread. |
| Anastomosis | Any stage | Colon or rectum | Surgical connection of the two healthy parts of the gastrointestinal tract above and below the part that has been removed. It restores bowel continuity and bowel function. |
| Temporary or diverting colostomy (or ileostomy) | Any stage | Colon or rectum | If the remaining colon or rectum cannot be joined immediately, this procedure involves redirecting the cut end of the colon (or ileum) to an opening (stoma) in the abdominal wall. A bag attached to the skin of the abdomen collects waste to be discarded. Once the intestine is healed enough, the intestines can be reconnected and the stoma can be closed. |
| Permanent colostomy (or ileostomy) | Any stage | Colon or rectum | This procedure involves redirecting the cut end of the colon (or ileum) to an opening (stoma) in the abdominal wall. A bag attached to the skin of the abdomen collects waste to be discarded. |
| Ileal pouch (includes J-pouch, S-pouch, K-pouch) | Any stage | Rectum | After total proctocolectomy, a segment of the ileum is used to make an internal pouch to hold stool until defecation through the anus. |
What are the possible complications from colorectal cancer surgery?
All surgeries have a risk of complications. The type of surgery being done and your general health affect the likelihood of complications. The most common immediate complications are bleeding, blood clots, and infection. Rarely there may be a leak at the joining of two parts of the intestine (anastomotic leak). Long-term complications include internal scar tissue called adhesions that can cause bowel twisting or blockage, and permanent colostomy or ileostomy.
What is recovery like for colorectal cancer surgery?
All surgeries require recovery time. The extent of the surgery and your general health affect your recovery. Minimally invasive procedures usually have a shorter recovery period than open abdominal surgeries, including shorter time until normal bowel function returns, shorter hospital stay, and shorter recovery at home. For example, after a laparoscopic colectomy, bowel function typically returns in 1-3 days, and patients spend 3-5 days in the hospital. Full recovery to normal levels of activity usually takes 2-3 weeks. Sometimes your healthcare team will recommend changes in diet and physical activity before surgery to help your postoperative recovery and healing. This is called prehabilitation.
During your hospital stay, you will receive wound care and pain medications. You will start drinking and eating gradually, with most patients able to eat solid foods within a few days. You will also increase your physical activity gradually. Patients are usually out of bed and walking in the first day or two. If you have a temporary or permanent colostomy or ileostomy, you will receive ostomy care. You will also be taught how to manage your wounds, pain, and ostomy at home before you are discharged from the hospital.
The American Cancer Society has published helpful patient guides for more information about colostomy and ileostomy.
If your oncology team has determined that you need further cancer treatment after surgery, your adjuvant treatment will begin after you have healed and recovered.
