Surgery for colorectal cancer

This page was reviewed under our medical and editorial policy by Chukwuemeka Obiora, MD, Surgical Oncologist

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Surgery is the most common treatment for colorectal cancer and may range from minimally invasive, such as removing a polyp during a colonoscopy, to, in rare cases, removing the entire colon. Many surgeries for colorectal cancer involve removing tumours, the section of the colon in which the tumours was found, surrounding normal tissue and nearby lymph nodes.

Patients may receive chemotherapy and/or radiation therapy before and/or after surgery for colorectal cancer. These adjuvant therapies may help shrink tumors before they are surgically removed and are intended to target cancer cells that may remain after surgery.

The colon must be clean and empty for colorectal surgery. You’ll need to do “bowel prep” beforehand, whether you’re having a polyp removed during a colonoscopy, or the surgeon is removing part of your tumor and colon and/or rectum in order to help treat cancer. Several methods are available to ensure you have a clean colon before surgery, including:

  • Pills
  • Drinks
  • Enemas

These can all be used as laxatives to flush out your colon, and your care team can tell you what to do and expect. Prepare to spend time in the bathroom the day or night before surgery.

The type of colorectal surgery you have depends, in part, on the cancer stage. Early-stage cancers may be treated through a local procedure in which the surgeon doesn’t need to cut through the abdomen. Advanced-stage cancers may require more complex surgery in which a surgeon removes all or part of the colon and/or rectum. If the cancer has spread to other parts of the body, such as the liver, colorectal cancer treatment may involve surgery to remove tumors in those distant areas as well.

Local excision, polypectomy and endoscopic mucosal resection: If colorectal cancer is found early—at stage 0 or 1—your care team may be able to remove the cancer through procedures used during a colonoscopy. These procedures don’t require cutting through the abdomen, because the doctor is able to access the colon or rectum through the anus with a colonoscope and an attached cutting tool or snare that removes the polyps or abnormal cells. If a polyp or area of abnormal cells cannot be removed during these procedures, then laparoscopic or open surgery may be required.

  • Polypectomy: If the excision involves the removal of a colorectal polyp, the procedure is called a polypectomy.
  • Local excision: If the excision involves removing cancerous cells and some surrounding tissue through a colonoscope, it’s called a local excision. This surgery is a bit more complex than a polypectomy, and it may require more time to recover.
  • Endoscopic mucosal resection: The removal of a stage 1 or stage 2 colorectal cancer with a colonoscope is called endoscopic mucosal resection (EMR). Your doctor may perform a polypectomy or EMR if polyps are found during a colonoscopy or sigmoidoscopy.

Colectomy: A colectomy is the removal of all or part of the colon. The resection may be performed as a less invasive laparoscopic colectomy. If open surgery is needed, a long incision in the abdomen may be required. With open surgery, patients may need to stay in the hospital for a week or more and face a longer period of recovery.

  • Removing part of the colon: The surgeon will remove the cancerous cells as well as some healthy tissue on either side of the tumor. During the surgery, the new ends of the colon will be reattached so there are no gaps. This is called a hemicolectomy, partial colectomy or segmental resection. Your surgeon may also remove some nearby lymph nodes.
  • Removing all of the colon: More rarely, the surgeon may need to remove all of the colon, called a total colectomy. This is typically only necessary when there are other problems in the colon besides cancer, such as inflammatory bowel disease or hundreds of polyps.

When possible, a surgical oncologist will perform a laparoscopic colectomy to remove the cancerous portion of the colon and nearby lymph nodes, and then reattach the healthy ends of the colon. A laparoscopic colectomy may result in less pain, a shorter stay in the hospital and a speedier recovery.

With a laparoscopic colectomy, approximately four to five small incisions are made around the abdomen. The surgical oncologist then inserts a laparoscope, a thin tube equipped with a tiny video camera that projects images of the inside of the abdomen on a nearby monitor. The surgical oncologist then inserts instruments through the incisions to perform the surgery.

How long colorectal surgery takes depends both on your surgeon’s goals and what’s found during the procedure. In general, colorectal surgery may take 1.5 to 3 hours to complete, but you should ask your care team what to expect based on the specifics of your cancer treatment.

Colostomy: A colostomy may be necessary, depending on the type and extent of the colorectal surgery performed. During this procedure, the colon is connected to a hole in the abdomen (called a stoma) to divert stool away from a damaged or surgically repaired part of the colon or rectum. Some colostomies may be reversed once the repaired tissue heals. Other colostomies are permanent, and the stoma is attached to a colostomy bag that collects waste.

You should ask your care team to discuss your specific recovery and expectations with you.

Proctectomy: A proctectomy is performed to remove all or part of the rectum.

  • A low-anterior resection (LAR) involves the surgical removal of cancer located in the upper part of the rectum, which is closest to the S-shaped sigmoid colon. Some adjacent healthy rectal tissue may also be removed, along with nearby lymph nodes and fatty tissue. A pathologist may examine the lymph nodes to determine if cancer cells are present. This will help doctors determine the stage of the disease and whether additional colorectal cancer treatment is needed. After the cancerous portion of the rectum is removed, the surgical oncologist connects the sigmoid colon with the remaining healthy tissue located in the lower part of the rectum. This allows waste to pass normally out of the body through the anus.
  • Abdominoperineal resection is used to treat cancer in the lower rectum. Because this procedure requires surgical removal of the cancerous portion of the lower rectum nearest the anus, some or all of the anal sphincter is also removed. The sphincter is a muscle that keeps the anus closed and prevents stool leakage. Because the sphincter is responsible for bowel control, the surgical oncologist also performs a colostomy to enable the body to excrete waste.
  • Anastomosis is a procedure that removes the entire rectum but connects the colon to the anus so you can pass stool normally. Your surgeon may create a pouch where your rectum would be to make room to store stool.
  • Pelvic exenteration is a complex operation to remove the rectum and other organs that the cancer has spread to, such as the bladder. Recovering from this surgery can take months and depends on which organs are removed. You typically need a colostomy after this surgery.

HIPEC: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery.

Unlike systemic chemotherapy delivery, which circulates throughout the body, HIPEC may deliver chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment.

HIPEC may be particularly helpful for colorectal cancer patients with abdominal tumors that have spread to the inside of the abdomen but have not spread to organs such as the liver or lungs, or to lymph nodes outside the abdominal cavity.

Robotic surgery: The da Vinci® Surgical System may be used to perform a colectomy and/or a low anterior proctectomy. The surgeon may use an EndoWrist® Stapler during surgery to remove the malignant portion of the colon using the da Vinci system. The surgeon may also use Firefly™ Fluorescence Imaging to find blood vessels with good blood supply, which normally would not be seen under white light. Using this imaging system may allow the surgeon to help ensure there is good blood supply when reconnecting the colon and rectum.

Compared with traditional open surgery for colorectal cancer, the da Vinci system may require smaller incisions. Many colorectal cancer patients may also experience faster recovery time and speedier return of bowel function.

Possible complications from colorectal cancer surgery

Your experience after colorectal cancer surgery depends on which type of procedure you had and how it was done. Speak with your cancer care team about what to expect in your case.

As with all surgeries, colorectal cancer surgery involves risk. After the procedure, you may have a higher chance of bleeding. You also may develop blood clots or an infection. Sometimes, if your care team has reattached parts in your colon, rectum or anus, these may begin to leak. Your care team should monitor you closely for signs of this happening, such as fever or lack of appetite. They’ll also keep an eye out for signs of any adhesions (places where scar tissue from the surgery is affecting how your organs function) even after you leave the hospital.

After surgery, you’ll likely experience some pain. Your care team can help you manage with pain medications as you recover. It may take a few days to resume eating and drinking normally as your digestive tract heals.

Depending on which type of surgery you had, some people need a colostomy or ileostomy after surgery. These collect waste outside of your body—whether directly from the small intestine (ileostomy) or directly from the colon (colostomy)—that you would normally pass as stool through your anus. Sometimes this is a temporary part of your recovery, but it can often be permanent.

What to eat after colorectal surgery

Following surgery, it’s important to consume the right nutrients and give the body time to recover. Your care team typically provides clear liquids when you’re ready for them after surgery. You may be eating and drinking normally within a couple weeks.

Learn more about what to eat after colorectal surgery

In the weeks following surgery, eat several small meals a day, avoiding high-fiber foods and hard-to-digest foods such as:

  • Nuts
  • Seeds
  • Corn

In general, aim to stay hydrated by drinking enough water each day. If you have other health issues, be sure to ask your doctor how much liquid you should be aiming for—some people with kidney or heart issues may need to limit their fluids.

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