Surgery for Cancer of the Colon and Rectum
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Surgery is the primary form of treatment for colorectal cancer. Some patients will require only surgery, while some will also undergo chemotherapy or radiation therapy before or after surgery. Recent progress in treating cancer is partly a result of such combined treatments. If the needed surgical aspects of care cannot be adequately addressed by gastroenterology specialists using colonoscopic techniques, one or more of the following operations – performed by the colorectal surgeon or surgical oncologist with special training in colorectal surgery – may be necessary.
Often the surgeon can completely remove the cancer. The survival rate is highest for these “complete, curative resections.” The type of surgery used for each patient, though, will depend on the location and stage of the cancer.
The surgeon will sometimes remove the tumor, a small margin of surrounding healthy tissue, and adjacent lymph nodes. Other times an entire portion of the colon will need removal. In still other cases, the entire colon will be resected, sometimes including the rectum, sometimes including the anus.
But in many colon resections, the surgeon can remove the cancerous tissue and rejoin the ends or margins of the colon, without loss of function of the colon. In some cases, especially to treat more advanced cancers, the surgery may include a colostomy, in which the surgeon creates an artificial opening through which waste can pass to in an external bag. This arrangement is usually temporary and permits the resected portion of the bowel to heal. Permanent colostomies are rare today.
Laparoscopic Colon Resection
This new and advanced, minimally invasive surgery, allows our surgeons to remove a colon tumor or colon segment without a large surgical opening. The team makes small incisions at several locations in the lower abdomen and uses these to access the colon with endoscopic equipment. These tools are slender tubes, including a scope with a self-lit lens at the end, that permit the surgeon see and manipulate the colon. The surgeon can perform the surgery while watching a video monitor of the endoscopic images and instruments used to resect and suture the large intestine. The skilled surgeon can take advantage of these techniques (referred to as laparoscopic surgery when used in the lower-abdomen or pelvis) to resect tumors and repair the colon safely – providing for an easier procedure to undergo.
The laparoscopic approach means less blood loss, a shorter hospital stay, quicker healing, less pain, faster recovery (including of bowel function), and more prompt return to activities, when compared to open colon resection.
Open Colon Resection
In conventional open surgery of the colon, the surgical team makes a long incision in the lower abdomen. This gives the surgeon direct visual and manual access to the colon to remove a cancerous section or a length of the colon.
Rectal Cancer Surgery (including sphincter preservation for low rectal cancer)
When undergoing surgery for cancer of the rectum, patients are understandably concerned about the possible loss of continenance. Today, though, even for cancer in the lower rectum, the skilled surgical team can often remove the cancerous tissue and preserve the nerves and muscles of the anal sphincter, permitting the patient to retain bowel control. Preoperative radiation therapy, combined with precise surgical technique help to remove early-stage cancer, helps to preserve the natural functions that control bowel movement.
Intraperitoneal (IP) Chemotherapy (including for pseudomyxoma peritonei)
When colorectal cancers have invaded the peritoneal cavity – meaning the space outside, between, and on the surface of lower abdominal organs (intestines, liver, and stomach), as well as the lining and connective tissue (peritoneum) in the part of abdomen – the knowledgeable cancer team can treat the disease by infusing chemotherapeutic drugs into this area. The surgeon will place a catheter into the pelvic area, allowing the drugs to be introduced for varying periods of time into the peritoneal space and withdrawn. This increases the concentration of drugs acting on the cancer tissue and decreases the amount that reach the rest of body, compared to the conventional intravenous route of administration. The strategy enhances the cancer-killing effects of the drugs and decreases their systemic side effects. Typically, patients receive IP chemotherapy after surgery that removes as much of the visible cancer tissue as possible.
Intraperitoneal (IP) therapy can be an effective treatment for pseudomyxoma peritonei, an uncommon condition (also known as malignant appendical tumor) in which cancers cells have broken through polyps on the appendix and caused a spread of mucus-producing tumor cells within the pelvic area.
Sometimes when curative surgery is not possible, surgical treatment can still be beneficial in addressing and reducing symptoms. Colorectal cancers can cause pain or result in obstruction of the digestive tract. Surgery to debulk, or reduce the size of, tumors can help to alleviate some these situations. This type of surgery is meant to improve quality of life for the patient.
Another type of palliative surgery is colon resection for patients whose cancer has already spread to other parts of the body at the time of initial diagnosis. The step can help reduce later bleeding, blockages, and symptoms caused by colon masses and by tumor invasion of nearby organs.
Surgery for Metastatic Disease
Surgical treatment for colorectal may also be directed at sites to which the cancer has spread (or metastasized). Common sites for metastatic colon cancer include the liver and brain.
Today, it is possible to remove sections or large segments of the liver when this organ becomes cancerous. After hepatic resection, healthy liver tissue can partly regenerate.
Our team can refer patients for neurosurgical procedures as well.
Download this discussion on treating metastatic colorectal cancer, by Jeffrey T. Brodsky, Chief of Surgical Oncology at Aria Health: Download file (PDF format).
See also Aria’s Section on Colorectal Surgery.