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Colorectal cancer

Surgery for colorectal cancer

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.

Local excision and polypectomy: If colorectal cancer is found at an early stage, your doctor may be able to remove it, through a colonoscope, with a local excision that does not require cutting through the abdomen. If the excision involves the removal of a polyp, the procedure is called a polypectomy. The removal of a stage I or stage II 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.

During these procedures, a doctor accesses the colon or rectum through the anus with a colonoscope and an attached cutting tool or snare used to remove the polyps or abnormal cells. If a polyp or area of abnormal cells cannot be removed during these procedures, 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 may have 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.

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.

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

A low-anterior resection 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.

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 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.

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