Rectal cancer surgery is complex. Although curing the cancer is the most important goal, preventing or reducing damage to bowel, urinary, and sexual functioning is also vital. In addition, avoiding a permanent ostomy is important to many patients.
Because of the specialized techniques required for rectal cancer surgery, finding a surgeon who is trained and experienced in these techniques is important. The American Society of Colon and Rectal Surgeons can identify board-certified colon and rectal surgeons.
The location, size, and stage of rectal cancer are important in making decisions about whether the tumor can be removed. Surgical techniques to treat it involve:
- Polypectomy: Snaring and removing a polyp can be adequate to remove a very early rectal cancer if the cancer cells are limited to the inner lining of the rectum (mucosa) or the head and stalk of the polyp and if no cancer remains in tissue around the polyp (margins). Such cancers are stage Ts or in situ.
- Local excision where the surgery takes place through the anus. The tumor is removed along with a disc of normal tissue. Local excision is appropriate only when the tumor is small, does not invade the anal sphincter (muscle closing the rectum), and has not spread to lymph nodes.
- Low anterior resection (LAR) with anastomosis where an incision in made in the abdomen, the section of colon and rectum containing tumor and the surrounding tissue containing lymph nodes and blood vessels (mesentery) is removed, and the cut ends are sutured or stapled together. LAR “spares” the anal sphincter so that bowel movements can be made normally through the anus. LAR is appropriate when the tumor is high enough in the rectum to leave several inches of healthy tissue above the anus.
- Abdominoperineal rection (APR) with permanent colostomy removes the entire rectum with its mesentery and the anus. An opening is created in the abdomen and the end of the colon pulled through to create a colostomy for the passage of stool.
- Low anterior resection with a temporary diverting ostomy. Sometimes surgeons will create either a colostomy or ileostomy higher in the colon to divert stool so that the connection (anastomosis) made during surgery can heal. Once healing has occurred and any chemotherapy or radiation treatment after surgery is complete, the ostomy is reversed and bowel movements become normal again.
- Extended resection or exenteration. If rectal cancer has spread to nearby organs, such as the bladder, vagina, or uterus, or into pelvic bones, surgeons will try to cure the cancer by removing all the affected organs along with the rectal surgery.
Best surgical results are obtained when the surgeon removes the affected section of rectum, the tumor, and the surrounding mesentery in one complete “block” using a technique called total mesorectal excision (TME). TME gives the best chance to prevent rectal cancer from returning locally.
Where Can You Go for More Information
The Johns Hopkins University Digestive Disease Library contains an excellent technical discussion of surgery for colon and rectal cancer along with superb graphics.
The American Cancer Society has a simpler, patient-friendly discussion of colon and rectal surgery.
Shands Cancer Center at the University of Florida has further descriptions of surgery for rectal cancer.