Colon cancer surgery

Overview

Surgery often is the main treatment for colon cancer. Surgery options range from simple procedures done during a colonoscopy to more complex surgeries such as colectomy, where part or all of the colon is removed. The type of surgery that's right for you depends on the cancer's location and stage and the goal of the surgery. Your healthcare team considers your overall health and preferences when recommending the best approach.

In addition to surgery, your healthcare team might recommend other treatments, such as chemotherapy, immunotherapy or radiation therapy. These therapies may be used before, during or after surgery. They can be used to shrink cancer or help kill any remaining cancer cells that were not removed with surgery.

Types of colon cancer surgery

The types of surgery commonly used to treat colon cancer include:

Polypectomy

The purpose of a polypectomy is to remove growths in the colon, called polyps. The aim is to remove them before they can turn into cancer or to catch cancer early if it's just starting to grow. A polypectomy can be done during a colonoscopy. A colonoscopy uses a tiny camera on the end of a flexible tube, called a colonoscope, to visually examine the colon. During the colonoscopy, a medical specialist threads tools through the tube to remove the polyp.

Most polyps aren't cancer yet, but some can become cancerous over time if left alone. Removing them prevents that risk. If a polyp already shows signs of early cancer that hasn't spread, removing it might stop the cancer completely.

Colectomy

A colectomy, also known as a colon resection, is a surgical procedure to remove the cancerous part of the colon and the associated lymph nodes. When part of the colon is removed, the surgery is known as a partial colectomy. A total colectomy involves removing the entire colon.

To ensure the complete removal of cancer cells, healthy sections of the colon on each side of the cancerous section are removed. Nearby lymph nodes also are removed. After a colectomy, the remaining healthy ends of the colon may be connected, allowing waste to leave the body through the colon. This step is known as anastomosis.

A colectomy can be done using a single, long cut in the belly. This is called open surgery. Or it can be done using special tools through smaller cuts. This is called laparoscopic or robot-assisted surgery. The type of colectomy depends on the location and extent of the cancer.

• Partial colectomy. In this procedure, only the diseased part of the colon is removed. There are a few types of partial colectomy, depending on which section of colon is removed. Right or left hemicolectomy is removal of the right or left side of the colon. Sigmoid colectomy is removal of the sigmoid colon. Segmental resection is removal of a specific segment of the colon where the cancer is.
• Total colectomy. This procedure involves removing the entire colon while leaving the rectum intact. A total colectomy may be recommended for people with colon cancer who have a coexisting health condition, such as inflammatory bowel disease, Lynch syndrome or familial adenomatous polyposis.

Colostomy and ileostomy

The colon plays an important role in removing stool from the body. If the healthy ends of the colon cannot be connected during colectomy or another surgery, stool cannot pass through the colon as it typically would. When this happens, the surgeon may perform an ostomy procedure. An ostomy lets stool pass from your body without going through your colon or anus. Colostomy and ileostomy are common ostomy procedures used in colon cancer treatment.

During an ostomy, the surgeon brings a part of the intestine through an opening created on the belly, called a stoma. This allows waste to exit the body through the stoma rather than the rectum. The stoma typically appears as a red, moist and slightly bulging piece of the intestine. A special pouch is attached to the stoma outside the body to collect waste. The pouch provides a discreet and hygienic way to manage passing stool.

Colostomies and ileostomies are similar. But they differ in the location of the stoma and the part of the intestine involved. A colostomy involves the colon, while an ileostomy involves the last part of the small intestine, called the ileum. For many people, these procedures are temporary and can be reversed once the colon heals. However, for some people, the procedure may be permanent.

Surgery for colon blockage

Sometimes the cancer grows and blocks the colon. This is called a bowel obstruction. If this rare complication happens, you might need surgery right away to fix it. A blockage can prevent the passing of stool or cause severe symptoms, such as pain, bleeding and vomiting. If the cancer is growing but hasn't totally blocked the intestine, surgery may be planned to clear the blockage and prevent complications.

The most common surgery for colon blockage is a colectomy to remove the blocked section of the intestine. That sometimes is followed by a colostomy or ileostomy. Depending on the situation, one of these simple ostomy procedures may be done without removing part of the colon.

For some people, colectomy isn't an option. This could be due to the size and location of the cancer, a person's health, or because there are multiple tumors. Other types of surgery include:

• Bypass surgery. A bypass procedure connects a part of the intestine above the blockage to a part below the blockage. That bypasses the obstructed area and creates a new, clear pathway for waste. This allows the digestive system to function as it typically would despite the blockage. A bypass procedure most often is used to ease symptoms.
• Stenting. Stenting is a minimally invasive procedure done with a colonoscope. It involves placing an expandable metal tube in the colon to keep the colon open and allow waste to pass through. Stenting can be a temporary or permanent solution. This procedure helps relieve symptoms of obstruction and can serve as a bridge to surgery. Stenting most commonly is done for cancer growing in the left side of the colon.

Sometimes, a bypass or stenting procedure may be done first, followed by a colectomy at a later time.

Surgery for cancer spread

Colon cancer that has spread to other parts of the body is called metastatic colon cancer. It most often spreads to the liver or lungs. But it also can spread to other places such as the brain, distant lymph nodes or the lining of the abdominal cavity, called the peritoneum.

Treating metastatic colon cancer may involve more than one surgery. Removing the original cancer, called primary cancer, may be done first. That may be followed by a separate surgery to remove the metastatic cancer. Sometimes, only one surgery is needed to remove all the cancer. Chemotherapy, radiation or other therapies may be used before, during or after surgery to help shrink cancers or kill cancer cells.

• Resection. Resection is a surgical procedure that involves removing cancerous tissue. Liver resection, which involves removing a part of the liver, is a common surgery for metastatic colon cancer. Depending on the extent of the cancer, resection may improve the prognosis or even cure the cancer.
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, also called HIPEC. This is a specialized combination treatment used for cancer in the abdominal cavity, called the peritoneum. Cancerous tumors are first surgically removed from the peritoneum. The cavity is then bathed with hot chemotherapy — heated to 42 degrees Celsius — to kill any microscopic cancer cells that remain.

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The main goal of colon cancer surgery is to remove cancerous tissues and prevent the spread of cancer. Surgery also can ease symptoms and improve quality of life. For many people with early-stage colon cancer, surgery alone can completely remove cancer and possibly be a cure.

Often, surgery is done to see how far the cancer has spread within the belly. This can help with decisions about the next best steps for your treatment.

المخاطر

Colon cancer surgery carries a risk of serious complications. Minimally invasive approaches, such as laparoscopic and robotic surgery, may have shorter recovery times and fewer complications. But not everyone can have this type of surgery.

Your risk of complications is based on your general health, the type of surgery you have and the approach your surgeon uses to perform the operation. In general, complications of colon cancer surgery can include:

• Bleeding.
• Blood clots in the legs, called deep vein thrombosis.
• Blood clots in the lungs, called pulmonary embolism.
• Infection.
• Injury to organs near the colon, such as the bladder, ureters and small intestine.
• Formation of scar tissue after surgery, called adhesions, that can cause blockage in the intestine.
• Leaking at the connection site, called an anastomosis, where the healthy ends of intestine were joined.

After surgery, you spend time in the hospital to allow your digestive system to heal. Your healthcare team monitors you for signs of complications from your surgery. You may spend a few days to a week in the hospital, depending on your condition and your situation.

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Discuss your procedure with a colon cancer surgeon

Before surgery you meet with a colon cancer surgeon who can explain what to expect from surgery. Prepare for this meeting by creating a list of questions to ask.

Questions to ask about surgery:

• What are my options for colon cancer surgery?
• Do you recommend an open or minimally invasive procedure?
• Will I need to have a colostomy or ileostomy? If so, will it be temporary or permanent?
• Will I also need to have other types of treatment, such as chemotherapy or radiation?

Questions to ask about risks and recovery:

• What are the risks associated with my surgery?
• What are my options for pain management?
• How much time will I spend in the hospital?
• How much time will I need for recovery?
• How soon can I eat and drink after my surgery?
• What kind of diet should I follow during my recovery? For how long?
• Will I need to limit my activities after surgery?
• When can I return to work?

Questions to ask if you have an ostomy:

• What does a stoma look like, and how do I care for it?
• How often do I need to change the ostomy pouch?
• Can I follow my typical diet after an ostomy procedure?
• How will an ostomy affect my daily life and routines, such as physical activity or intimacy?
• What are the possible complications or risks associated with an ostomy?
• How do I manage odor and leakage from the ostomy pouch?
• What support and resources are available for help with my ostomy?

Follow your healthcare team's instructions

During the days leading up to the procedure, your healthcare team may ask that you:

• Stop taking certain medicines. Certain medicines can increase your risk of complications during surgery, so your care team may ask that you stop taking them before your procedure.
• Fast before your surgery. You may be asked to stop eating and drinking several hours to a day before your procedure. Your care team will give you specific instructions.
• Drink a solution that clears your bowels. You may be prescribed a laxative solution that you mix with water at home. You drink the solution over several hours, following the directions. The solution causes diarrhea to help empty your colon. Your care team also may recommend enemas.
• Take antibiotics. In some cases, you may be prescribed antibiotics to suppress the bacteria found naturally in your colon and to help prevent infection.
• Stop smoking. Smoking makes it harder for the body to heal after surgery. Quitting smoking before surgery can lead to faster healing and fewer complications.
• Stay active. Physical activity before colon cancer surgery can enhance recovery and overall outcomes. It helps improve cardiovascular fitness, muscle strength and mental well-being. This may reduce complications during surgery and speed up postoperative recovery.

Before surgery, you may have a colonoscopy to check the size and location of the cancer. The cancer site may be marked with ink, similar to a tattoo. This makes it easier for the surgeon to find and remove the cancer during the surgical procedure.

Preparing for colon cancer surgery isn't always possible. For instance, if you need an emergency procedure due to bowel obstruction or bowel perforation, there may not be time to prepare.

Plan for your hospital stay

You'll spend at least a few days in the hospital after your surgery, depending on your situation. Plan for someone to take care of your responsibilities at home and at work. Think ahead to what you might like to have with you while you're recovering in the hospital.

Things you might pack include:

• A robe and slippers.
• Toiletries, such as your toothbrush and toothpaste and, if needed, shaving supplies.
• Comfortable clothes to wear home.
• Activities to pass the time, such as a book, magazine or games.

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During the procedure

What happens during your surgery will depend on the specific procedure, but generally, you can expect the following:

• Surgery prep. Members of your healthcare team take you to a preparation room where they monitor your blood pressure and breathing. You may receive an antibiotic through a vein in your arm to prevent infection.
• Anesthesia. You are taken to the operating room and positioned on the surgical table. You receive general anesthesia to put you in a sleeplike state so you won't be aware during the operation. Once you are asleep, the surgeon begins the surgery.

• Cancer removal. For procedures like polypectomy, no surgical cuts, called incisions, in the belly are needed. Other colon cancer surgeries require one or more cuts in the belly. In open or conventional surgery, a single large incision is made. In minimally invasive surgery, several small incisions are made for laparoscopic tools.

  The surgeon locates and removes the cancer. The surgeon also removes nearby lymph nodes to see if the cancer has spread. If possible, the remaining parts of the colon will be reconnected to restore bowel function.

• An ostomy procedure, if necessary. If it isn't possible to reconnect the remaining parts of the colon, a colostomy or ileostomy may be done.

After the procedure

After surgery you are taken to a recovery room. Here the healthcare team can watch you as the anesthesia wears off. Then your healthcare team takes you to your hospital room to continue your recovery.

• Regaining bowel function. You'll likely stay in the hospital until you are able to tolerate eating and drinking again. This may take a couple of days to a week. You may be encouraged to start on a general diet and eat what sounds good to you a few hours after surgery has ended. Many people find it helpful to eat small bites, chew thoroughly and pause between bites. Eating regular food can help your bowel function return.
• Wound care. Members of the healthcare team teach you how to care for your incision and manage any drains. They also will provide instructions for diet and activity levels.

• Ostomy care. If your surgery involved a colostomy or ileostomy to attach your intestine to the outside of your abdomen, someone on your healthcare team will show you how to care for your stoma. The nurse will explain how to change the ostomy bag that collects waste.

  For some people, an ostomy is only temporary until the bowels have a chance to heal. The healing process typically takes a few weeks or months, but sometimes it can take longer. Once the bowel is healed, the ostomy can be reversed, and the bowel will work like it did before.

You'll have follow-up appointments to check on your recovery and discuss further treatment options, if needed.

النتائج

The results of your colon cancer surgery show whether all of the cancer was removed. If your healthcare professional wasn't sure about the cancer's stage before surgery, the results may provide that important information. Ask your healthcare team when you can expect to find out the results. Your care team may talk about the results with you at a follow-up appointment. Or they may contact you with the results as soon as they're available.

Many people with colon cancer have other treatments after surgery. Common treatments used after surgery include chemotherapy, immunotherapy and targeted therapy. When you might begin other treatments depends on your cancer. Ask your care team if more treatment is recommended.