Colorectal Cancer Surgery

Listed below is the step by step procedure of colorectal cancer surgery:

  1. What is Colorectal Cancer Surgery?
  2. Why is Colorectal Cancer Surgery Required?
  3. Pre-operative Preparation
  4. Day Before Surgery
  5. Procedure Day
  6. Methods/Techniques of Colorectal Cancer Surgery
  7. Post Procedure
  8. Risks and Complications

What is Colorectal Cancer Surgery?

Colorectal cancer affects both colon as well as rectum. Origin source of cancerous tumor can either be in colon or in rectum. But, eventually the tumor spreads to both colon and rectum leading to colorectal cancer. Surgical procedures employed to treat colorectal cancer involve removal of cancerous or malignant tumor. If the tumor has spread to the entire colon or rectum, then the affected organ has to be removed entirely to avoid metastasis (spread of cancer).

colorectal cancer surgery

Sometimes, healthy portions of colon or rectum surrounding the tumor can be removed in order to eliminate possibility of recurrence of cancer. Surrounding lymph nodes may also be removed and the ends of the colon or rectum will be re-attached to intestines. Surgery is the primary treatment for colorectal cancer. Type of surgery that is to be performed will depend on the stage of colorectal cancer.Sometimes, healthy portions of colon or rectum surrounding the tumor can be removed in order to eliminate possibility of recurrence of cancer. Surrounding lymph nodes may also be removed and the ends of the colon or rectum will be re-attached to intestines. Surgery is the primary treatment for colorectal cancer. Type of surgery that is to be performed will depend on the stage of colorectal cancer.

Early diagnosis plays an important role in treatment of colorectal cancer. Earlier it is detected, less complex is the surgery type chosen. Also, in early stages, it is possible to cure cancer. But, as it advances, difficulty level of treating cancer rises and chances of getting cured completely reduce.

Why is Colorectal Cancer Surgery Required?

Surgery enables oncologists to remove tumor in the most easiest way possible. It is the one of the most reliable approach to treat malignant (harmful) tumor and reduce chances of recurrence of colorectal cancer. Also, surgery is the basic treatment procedure implemented to treat colorectal cancer in its germinating stages. If the cancer has advanced to higher level, other treatment techniques like chemotherapy and radiation therapy may also be used along with surgery.

There are several techniques or approaches of colorectal cancer surgery. Depending on patient's overall health and the stage of colorectal cancer, oncologist decides which type of colorectal surgery procedure is to be adopted.

Panel of doctors, nutritionists and rehabilitation therapists may work together and decide the approach of surgery. This will be done in such a way that risks and complications associated with the surgery are reduced.

Pre-operative Preparation

Before you opt for colorectal cancer surgery, your doctor will give an elaborate idea regarding preparation for your colorectal cancer surgery. Below mentioned are few points that are applicable to almost all colorectal cancer patients.

  • Preparing your colon and rectum:

    It's important that patient takes measures to keep rectum and colon clean before he/she undergoes surgery. This will help the treatment to become more efficient and beneficial. For a week, the patient is advised to be on light diet. Spicy foods, fried foods, different types of meats and foods that take long time to get digest are to be avoided. Foods that are easily digested such as boiled rice, boiled lentils, vegetables and wide variety of salads are advisable to be consumed a week prior to colorectal cancer surgery. However, the procedure of preparing your colon and rectum may vary for individuals. Your oncologist will chalk out preoperative plan for you as per your individual requirements.

  • Medication prescription:

    In case if the oncologist prescribes you some medications before the surgery is conducted, make sure that you follow these.

  • Physical examination and health history

    Physical examination will be conducted by doctor to check your overall health status. Also, along with physical examination, doctor may ask you to undergo some diagnostic tests such as blood test, sugar test etc. to check for presence of any abnormality. Your blood pressure level will also be monitored. Your past health history also plays a significant role in deciding the technique of colorectal cancer surgery. If your past history comprises of cardiovascular disease, diabetes or any other major health issue, then the approach for colorectal cancer surgery may be altered. Hence, its important that patient lets the doctor know about his past health history and other complications he might have faced.

  • Diagnostic tests:

    Diagnostic tests may be conducted again to check current stage and metastasis of colorectal cancer. However, this step can be optional depending upon the time period when they were first conducted to determine presence of colorectal cancer and its stage.

  • Arrangement for blood transfusion:

    Since any surgical procedure involves loss of blood, chances of blood transfusion may arise. Hence, to compensate this loss of blood, arrangements for blood transfusion should be made. This is better done a week before instead of doing it on the day before surgery to avoid last minute hassle.

The above mentioned preoperative measures may vary from patient to patient. Your oncologist will help you with preoperative stuff.

Day Before Surgery

Your oncologist will brief you about what to do the day before the surgery in terms of your health and preparation. You have to get admitted to the hospital day before the surgery. This might include:

  • Diet:

    A day before the surgery, patient is supposed to be on liquid diet. Water, soups, broths, fluids in form of coconut water, fresh fruit juices etc. can be consumed. It's important that your body remains well hydrated and you get required nutrients too. Hence, soups and fresh fruit juices and vegetable juices help in fulfilling both these criteria. Nothing should be consumed on the night prior to the surgery. Laxatives will be given to clear the bowels

  • Legal documents and registration:

    You have to sign few legal documents before you undergo colorectal cancer surgery. These legal documents are indispensable. If you have medical insurance, you can complete the formalities with the insurance firm to take care of monetary requirements.

  • Random tests:

    Oncologist will examine your pulse rate, body temperature, blood pressure level, respiratory rate etc. at constant intervals. Antacids to curb acidity may be prescribed to the patient.

Procedure Day

On the day of surgery vitals like blood pressure, pulse rate and body temperature are also checked before anesthesia is injected. and General anesthesia is administered which induces unconsciousness in the patient during the surgery. The region where anesthesia is to be administered is first shaved and cleaned with antiseptic solution . Once, the effect of anesthesia takes over, surgery is commenced.

Methods/Techniques of Colorectal Cancer Surgery

There are several surgical techniques used for treatment of colorectal cancer. All these techniques serve one common purpose - kill cancerous cells. Let us understand about these surgery techniques in detail.

  • Colectomy
  • Proctectomy
  • Colostomy
  • HIPEC
  • Local Excision and Polypectomy

Colectomy

Colectomy is an inpatient surgical procedure employed to remove cancerous tumor or cancerous cells present in colon. Surrounding healthy portions of colon may also be removed in order to ensure complete removal of cancerous tissues and reduce risk of cancer recurrence. In most of the cases where cancer development can be curbed, around one-fourth to one-third of the colon is removed.

colectomy

There are two approaches of performing colectomy - open surgery and laparoscopic colectomy. In open surgical approach, a long incision is made on the abdominal region. Surgical tools are then used for freeing the colon from surrounding tissue. The surgeon will then cut a part of colon (partial colectomy) or if necessary the entire colon (total colectomy). Patient is required to stay for a week in the hospital.

Laparoscopic surgery is a less invasive approach wherein recovery period and hospital stay is reduced significantly. Four to five small incisions are made around the abdominal region through which laparoscope is inserted. A laparoscope is a thin, flexible tube equipped with a tiny video camera that helps in projecting images of internal structure of abdomen on the monitor. With help of these images, surgeon is able to evaluate precise area where malignant tumor is spread. Surgical oncologist then inserts instruments through these incisions to get rid of cancerous tumor.

A procedure called as lymphadenectomy may also be performed if cancerous cells have invaded nearby lymph nodes. Pathologist is also present during the surgical procedure so that he can provide immediate results by analyzing lymph nodes under microscope to check presence of cancerous cells. In this way, surgeon is able to remove as many as cancerous tissues as possible. Once, the complete surgical procedure is done, healthy ends of colon are reconnected.

Proctectomy

Proctectomy is a surgical procedure used to remove affected cancerous part of rectum or entire rectum if cancer has advanced to later stage of colorectal cancer. A low anterior resection procedure is used to remove cancerous tumor located in upper part of rectum whereas abdominoperineal procedure is used to treat malignant tumor present in lower portion of rectum. During both the surgeries, pathologist is also present to check whether cancer has metastasized to surrounding lymph nodes and fatty tissues. If the cancer has metastasized, surrounding lymph nodes and fatty tissues are also removed.

In low anterior resection procedure, after removal of cancerous tissues from upper part of rectum, healthy portion of remaining rectum is connected to sigmoid colon. This allows the waste materials to be excreted from the body through anus.

In abdominoperineal procedure, cancerous tissues from lower rectum are removed. This also involves complete or partial removal of sphincter muscle. It is the muscle that keeps anus closed and hence, prevents leakage of stools. If sphincter muscle is completely removed, surgical oncologist will create an outlet to eliminate waste materials from the body.

Colostomy

colostomy

Colostomy is essential if surgical oncologist is unable to reconnect healthy part of colon and rectum after performing abdominoperineal procedure or when complete removal of sphincter muscle. In this case, an artificial opening called as stoma is made in the lower abdominal region to eliminate waste materials from the body. Stoma is created on the outside portion of the abdomen to which segment of colon is attached. Colostomy bag is attached to stoma to collect waste. It is an odor-free bag and can be disposable.

HIPEC

Hyperthermic intraperitoneal chemotherapy (HIPEC) procedure is especially beneficial to advanced stage cancer patients wherein cancer has not metastasized to organs such as liver or lungs and to lymph nodes located outside abdominal region. This procedure delivers chemotherapy directly to cancerous cells present in the abdominal region during surgery.

Local Excision and Polypectomy

Local excision and polypectomy procedure is usually implemented to treat colorectal cancer at stage I or stage II.

Through colonoscopy, surgical oncologists are able to remove malignant tumor if the cancer is in either stage I or stage II. The surgery is performed with the help of colonoscope which is a flexible and thin tube equipped with light and camera. The attached video camera enables oncologist to precisely point out the location of malignant tumor and the extent where it has spread. The surgery does not involve extensive wear and tear of tissues. When malignant tumor is removed with the help of colonoscope, it is called endoscopic mucosal resection (EMR). If the procedure involves removal of polyp, it is called polypectomy.

Post Procedure

Once, the patient undergoes colorectal surgery, he has to follow certain parameters to ensure quick and hassle-free recovery. Every patient wants to know about some precautions that have to be practiced to reduce chances of cancer recurrence. Studies have shown that practicing healthy habits might prove useful in preventing colorectal cancer recurrence. To reduce your worry, we have compiled few tips on recovery post colorectal cancer surgery:

  • Follow-up schedules:

    Follow-up schedules as planned by doctor must be adhered to in order to check the outcome of colorectal cancer surgery and also, to check if the cancer has recurred or not. Periodical doctor appointments help in keeping a tab on your recovery. Also, the medications that have been prescribed by your oncologist have to be taken on time. After a period of 3 months or so, colorectal cancer diagnostic tests, such as imaging tests (CT Scan, MRI Scan), colonoscopy and blood tests will also be conducted to assess cancer recurrence.

  • Being active:

    Being active not only helps you to stay off physical ailments but also promotes production or secretion of “feel positive hormones.” Exercise helps you in staying healthy, which in turn goes a long way in keeping you fit and fine. Also, research has revealed that patients who remain active physically are at less risks of recurrent cancer. There is no measure or restriction on activity time limit. From 15 minutes to an hour of physical activity is essential to keep you healthy.

  • Healthy diet:

    Time and again we have heard that healthy diet leads to healthy life. Well, healthy diet plays even more important role in accelerating speed of recovery and healing post colorectal cancer surgery. Consume diet that is rich in plant sources. It helps in detoxifying your body and is also comparatively easy to digest than any animal based foods. Refined sugar, processed meats and genetically modified foodstuffs are strictly not allowed if you take recovery seriously.

  • Artificial supplements:

    You may have to rely on artificial supplements for few days to compensate mineral and vitamin loss that may have taken place during surgery. Iron supplements will help in increasing blood count and prevent condition of anemia. Calcium supplements will help your bones to become strong. Vitamin D may also help in preventing recurrence of colorectal cancer, but this has not yet been confirmed. Easy and the cheapest way to obtain vitamin D is exposing yourself to early morning sun and consuming eggs and seafood.

  • Smoking and alcohol:

    Smoking and alcohol both affect the health of patient and make recovery process slow. Smoking increases probability of colorectal cancer recurrence. Quitting both these habits will not only help in reducing chances of colorectal cancer recurrence but also will help in improving overall health.

  • Palliative care:

    Emotional support goes a long way in uplifting will power of patient and make him feel good. Long rounds of hospital visits and stay will create a negative impact. Hence, love and affection of close and near ones are indispensable for the patient to recover completely. Motivational, encouraging and kind words should be spoken with patient.

Risks and Complications

Though surgery proves beneficial in eradicating malignant tumor, it does have its share of negatives. Before you opt for surgical procedures, ask your oncologist about the side-effects and how to deal with them. Let us have a look at risks and complications of colorectal cancer surgery:

  • Anesthesia issues:

    Anesthesia given before surgery may produce some allergic reactions in some patients. Nausea, headache, respiratory troubles etc. may develop in some patients. However, these symptoms generally fade away with time.

  • Bleeding and infection:

    Chances of infection increase post colorectal surgery as immune system is also weak and bacteria may develop in the the operated part. Surgery involves loss of blood; especially if it's performed in traditional way. No surgery is possible sans bleeding. It involves wear and tear of tissues and hence, blood transfusion is advised in emergency cases.

  • Accidental injury to surrounding organs:

    While surgery is being performed, accidental injuries can happen to surrounding healthy organs. So, little healthy portions of the operated organ are removed so that even if cancerous cells have leaked into these tissues, chances of recurrence of cancer are eliminated.

  • Emptying bowels:

    Patients who have undergone colorectal cancer may face bowel issues; especially if the entire colon or rectum has been removed. Though, surgeon makes another provision to eliminate waste and toxic materials from your body by creating an outlet, it still becomes uncomfortable for the patient to empty bowels. Also, there could be possibility of blood drops to be found in bowels. Patient may experience difficulty in passing bowels. Consult your oncologist if you experience immense pain or feel utterly uncomfortable with bowel issues.

Colorectal cancer surgery can help in prolonging life of cancer patients. It is the primary treatment adopted to treat colorectal cancer.



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