Surgery for Colon & Rectal Cancers

One phase of the colorectal cancer treatment process is often surgery. Your oncologist will be able to see where the cancer is located and determine if surgery can be done to effectively remove all of it. 

Several types of surgery are used to remove colorectal cancer. The right surgery for you depends on the type and stage of your cancer, where it’s located in the colon or rectum, potential side effects of the surgery, and your overall health.

What Are the Types of Colorectal Cancer Surgeries?

Polypectomy

During a colonoscopy, the physician can remove cancerous polyps in the colon. This is possible when there are only a few suspicious polyps that aren’t too large. Larger polyps can be removed during a polypectomy with special tools that remove the polyp and a small amount of the colon’s inner lining, called an endoscopic mucosal resection.

Colectomy

Colectomy surgery is typically performed either laparoscopically or with open surgery. The right method is based on several factors including where it’s located and if it’s likely to have spread.

• Laparoscopic surgery, or minimally invasive surgery, removes polyps that cannot be removed during a colonoscopy. It can also be used to remove early-stage cancer in the rectum. While a patient is under anesthesia, several small incisions are made in the abdomen. Laparoscopes (thin, lighted tubes with attached camera) are passed into the abdomen. The inside of the colon is displayed on a video monitor and guides the removal of the cancerous area and some lymph nodes near the cancer. 
• Open surgery uses an incision in your abdomen to remove the cancerous area, some of the colon or rectum, and some nearby lymph nodes. This is more common for larger tumors or cancer that appears to have spread outside of the colon. Also called surgical resection, open surgery requires a longer hospital stay and longer recovery. During surgery, the surgeon can also view the rest of the intestine and liver to check for cancer that’s spread.

The type of colectomy is primarily based on the amount of the colon that needs to be removed to target the cancer. 

• Partial colectomy (also called hemicolectomy or segmental resection) removes the cancerous part of the colon and nearby tissue and lymph nodes. Anastomosis is the procedure used to rejoin the colon, so bowel function is similar to what the patient had before cancer. This procedure is commonly done via laparoscopy.
• Right colectomy removes the right side of the colon; an ileocolectomy removes the last segment of the small intestine (ileum) from the right side of the colon where it’s attached.

Total Proctocolectomy

• This is the most extensive colorectal surgery. The surgery removes the rectum and colon. If the surgeon can leave the anus and it works normally, they may make an ileal pouch to manage waste material. But if the anus has been removed or is weak or damaged, a permanent ileostomy is needed. The pouch is made from the end of the small intestine. It’s sewn or stapled to form a pouch that holds waste matter. The most common method is a “J” pouch. The surgeon may also create a temporary ileostomy to divert fecal matter while the permanent pouch heals. 

Proctosigmoidectomy 

• This surgery removes the cancerous section of the lower colon called sigmoid colon as well as the rectum. 

Rectal Cancer Surgeries

• Abdominoperineal resection removes the anus, rectum, and lower colon (sigmoid); it requires a permanent colostomy.
• Transanal endoscopic surgery removes larger cancers that are higher in the rectum or difficult to remove. Your surgeon will use instruments that are inserted through the anus into the rectum.
• Local transanal resection or excision removes early-stage rectal cancers in the lower rectum. It is performed by instruments inserted through the rectum. 
• Low anterior resection removes stages 1, 2, or 3 cancers in the upper rectum. The colon is reattached to the remaining rectum. The incisions are made through the abdomen.
• Proctectomy, used primarily for stages 2 and 3 cancers in the middle and lower rectum, removes the entire rectum. Your surgeon may create a pouch in the colon to replace the rectum. The colon is then attached to the anus.
• Abdominoperineal resection, used with stages 2 or 3 cancers in the lower or middle rectum, removes the rectum through abdominal incisions. The anus and sphincter muscles are removed through incisions around the anus.
• Total mesorectal excision removes the entire rectum. Removing lymph nodes and blood vessels near the rectum can lower recurrent cancer risk to 5 or 10%.