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by Badash M

Surgical Procedures for Colorectal Cancer

If colorectal cancer has not spread beyond the colon or lymph nodes, surgical removal of the cancer is the most common treatment. Surgical procedures for rectal cancer are more complex than for colon cancer. In rectal surgery more tissues and muscles related to urinary and sexual functions are involved.

Colon Surgery

Polypectomy and Local Excision

A colonoscope is placed through the anus and rectum, up into the colon. Instruments are inserted through the colonoscope tube to remove early stage cancer.

Partial Colectomy

If the cancer is larger, both the cancer and a small amount of healthy tissue and nearby lymph nodes will be removed. This is called a partial colectomy. In many cases, the healthy portions of the colon and rectum are reconnected. This reconnection procedure is called anastomosis. If your surgeon can possibly preserve your anal function, and ultimately avoid the need for a permanent colostomy, that is generally considered a preferred procedure.

Laparoscopic-assisted Colectomy

In some cases, it is possible to remove part of the colon and nearby lymph nodes through several small incisions in the abdomen. Laparoscopes are equipped with cameras that allow the surgeon to see inside the abdomen. Special instruments are inserted through tubes to remove the cancer. Healing time and recovery are somewhat faster than with an open colectomy .

Total Colectomy

A total colectomy is the removal of the entire colon. The last part of the small intestine, called the ileum, is then connected to the rectum. In some cases, a small pouch is made from the ileum to store stool. This pouch mimics the function of the rectum. This surgery preserves anal function and the need for a permanent colostomy.
Surgical Resection of a Colorectal Tumor Mass
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Colostomy

If it is not possible to reconnect the colon, a colostomy is necessary. A colostomy is a surgical opening (stoma) through the wall of the abdomen into the colon. This is used as a path for waste material to leave the body. After a colostomy, you will wear a special bag to collect body waste. The colostomy may be either temporary or permanent. In cases where the entire colon is removed, the small bowel will be used to create the stoma.

Rectal Surgery

Polypectomy and Local Excision

A colonoscope is placed through the anus, and up into rectum. Instruments are inserted through the colonoscope tube to remove early stage cancer.

Local Transanal Resection

This procedure is also called a full-thickness resection. Like the local excision procedure, a colonoscope is placed through the anus, and up into the rectum. The surgeon removes both the cancer and some surrounding healthy tissue. Local transanal resection is used for early stage cancers that are small and closer to the anus.

Transanal Endoscopic Microsurgery (TEM)

TEM is a highly specialized procedure that can be used for early stage cancers farther away from the anus. A magnifying scope and instruments are placed through the anus, and up to the rectum. In this procedure, the surgeon also removes the cancer and some surrounding healthy tissue. The remaining hole in the wall of the rectum is closed when the surgeon is done.

Low Anterior Resection

Low anterior resection is used to remove cancers high in the rectum closer to the colon. Access is gained through the abdomen. Part of the rectum where the cancer is, along with surrounding healthy tissue and lymph nodes are removed. The colon is attached to the remaining part of the rectum. This surgery does not affect the anus, so bowel movements are not affected.
If you have chemotherapy or radiation therapy before this procedure, you may have a temporary ileostomy. An ileostomy brings the last portion of the small intestine out through a hole in the abdominal wall. After an appropriate amount of time, the procedure may be reversed.

Proctectomy with Colo-anal Anastomosis

This procedure requires removal of the entire rectum because of the location of the cancer. Generally, this is done when the cancer is in the middle or lower third of the rectum. Once the rectum is removed, the colon is then attached to the anus. In some cases, a small pouch is made from the colon to store stool.
A temporary ileostomy may be necessary to allow the bowel to heal. After an appropriate amount of time, the procedure may be reversed.

Abdominoperineal (AP) Resection

An AP resection may be necessary if the cancer has spread from the rectum into the anal area. The surgeon removes the anus, the anal sphincter muscle, and surrounding tissue. After this procedure, you will need a permanent colostomy.

Pelvic Exenteration

If the cancer has spread beyond the rectum into nearby organs, a more extensive procedure will be necessary. The surgeon removes the rectum, along with the bladder, prostate, or uterus. After this procedure, a permanent colostomy will be necessary. If the bladder is removed, you will also need a urostomy. A urostomy is an opening in the abdominal wall that allows for the passage of urine.

References

Colon cancer treatment option overview. National Cancer Institute website. Available at: http://cancer.gov/cancertopics/pdq/treatment/colon/Patient/page4. Accessed May 15, 2013.

Colorectal cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003096-pdf.pdf. Updated January 17, 2013. Accessed May 15, 2013.

Colorectal cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated May 3, 2013. Accessed May 15, 2013.

Rectal cancer treatment option overview. National Cancer Institute website. Available at: http://cancer.gov/cancertopics/pdq/treatment/rectal/Patient/page4. Accessed May 15, 2013.

Total abdominal colectomy. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/total%5Fabdominal%5Fcolectomy/childrens%5Foverview.aspx. Accessed May 15, 2013.

9/18/2007 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed/what.php: Küchler T, Bestmann B, et al. Impact of psychotherapeutic support for patients with gastrointestinal cancer undergoing surgery: 10-year survival results of a randomized trial. J Clin Oncol. 2007;25:2702-2708.

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