This page was reviewed under our medical and editorial policy by
Chukwuemeka Obiora, MD, Surgical Oncologist
This page was reviewed on April 7, 2023.
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 tumors, the section of the colon in which the tumor 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:
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.
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.
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.
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.
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.
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:
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.