Colorectal Cancer Surgery

If you have received a colon or rectal cancer diagnosis, you will likely need colorectal cancer surgery. Your surgical options and the timing of when your surgery will take place depends on your stage and type of cancer.

Who needs colorectal cancer surgery?

Your options for surgery will depend on your stage of cancer and if you’ve been diagnosed with colon cancer or rectal cancer.

Nobody loves having surgery, but it’s a promising option for colorectal cancer patients. The goal of surgery is to remove cancer from your body. Sometimes surgery can remove all your cancer; sometimes it can only remove some of it. Colorectal cancer surgery can be an effective and efficient step in your treatment plan.

If you’re looking for a colorectal cancer surgeon, or would like to seek a second opinion, use our Provider Finder.

Colon cancer

If you’ve been diagnosed with colon cancer, your first treatment step may be surgery to remove the primary tumor, especially if it is a small or early tumor that can be entirely removed with the portion of affected colon.

Surgery and the subsequent examination of the removed colon and tumor will also allow doctors to assign a pathological stage to your cancer, which offers a better picture of the cancer’s extent and helps guide further treatment options.

A polypectomy, or local excision, removes a cancerous polyp from the body via colonoscopy without an abdominal incision, may take place for pre-cancerous polyps or in people who cannot tolerate an abdominal surgery.

All other cancers (Clinical stages I, II, III and IV) may require open or minimally invasive abdominal surgeries.

Rectal cancer

If you have been diagnosed with rectal cancer, you will likely be treated with radiation and chemotherapy before surgery. For females of child-bearing age with rectal cancer, an ovarian transposition may be recommended for fertility preservation prior to radiation therapy. Egg freezing in women or sperm banking in men is also an option prior to rectal cancer treatment because of the rectum’s close proximity to pelvic nerves and organs.

Watch and wait

In some rectal cancer patients, neoadjuvant treatment (treatment given before surgery) is sufficient for treating the cancer, and patients don’t need surgery. In these cases, patients may be offered the “watch and wait” approach as an alternative to surgery. These patients will be continually reassessed and monitored via physical exam and colonoscopy or sigmoidoscopy in the weeks and months following treatment to see if the cancer grows and/or returns and warrants surgery.

Will the surgeon cut me open?

Not necessarily—there are several surgical techniques that doctors use on colorectal cancer patients depending on the case. Surgery methods include:

Open Surgery

Open surgery is a type of surgery where a doctor makes a long cut (incision) down the middle of the abdomen to access the area where the surgery needs to be done. This type of surgery is usually done when the area being operated on is hard to reach, or when the surgery requires a larger opening to see and work in the area.

After surgery, the cut will be closed. The deeper layers of the abdominal wall are closed with sutures, and the skin will be closed with stitches or staples. Open surgery usually requires a longer recovery time and can be more painful than minimally invasive surgery. However, sometimes open surgery is the best option for certain situations.

Surgery Brochure
From side effects of surgery, types of colon and rectal cancer surgeries, questions to ask your medical team, to a packing list, the Fight CRC Colorectal Cancer Surgery brochure covers important information for you to consider – and things you may not have even thought about – before scheduling and heading to the hospital for your procedure. Make our medically reviewed Colorectal Cancer Surgery brochure your trusted resource.

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Minimally Invasive Surgery

LAPAROSCOPIC SURGERY

Laparoscopic surgery uses multiple small incisions instead of one long cut. The doctor inserts a tiny camera and small tools into the cuts to remove the cancer. This can make recovery time shorter and less painful.

ROBOTIC-ASSISTED SURGERY

Robotic-assisted surgery is like laparoscopic surgery, but the doctor uses a console in the operating room to control tools held by a robotic machine. This method allows the doctor to perform the surgery with more precision, flexibility, and control. Recovery time with this technique may also be shorter compared to open surgery.

What kind of surgery will I need?

There are several types of colorectal surgery. You’ll need to talk with your doctor about their recommendations depending on your diagnosis and your other health conditions.

Polypectomy

A polypectomy is most often performed during a colonoscopy and occurs when a doctor removes a polyp containing cancer cells from the colon. Although typically a minor and painless procedure, it’s considered a “surgery” and billed as such. This is usually the only surgery stage 0 or very early-stage I cancers need. You may not even be aware that you’ve had a polypectomy until your physician tells you!

Local Excision

Local excision is also considered a colorectal cancer surgery and billed as such. It does not require an abdominal incision and, like the polypectomy, is done by a colonoscope tool during a colonoscopy. During a local excision, a doctor removes the polyp containing cancer, as well as surrounding tissue, that will be sent to pathology for testing in order to determine the cancer’s stage.

Colectomy and Proctectomy

During a colectomy, parts of, or sometimes the entire colon is removed. When some colon can be preserved, the two ends of the remaining colon are reattached (creating what’s called an anastomosis) to restore bowel functions. There are several types of colectomies:

Right Hemicolectomy or Left Hemicolectomy – remove right or left side of the colon
Partial Colectomy/Subtotal Colectomy – remove some or most of the colon (technically LAR is in this category)
Total Colectomy – remove all of the colon
Proctectomy – remove all or part of the rectum
Proctocolectomy – remove colon and rectum
Total colectomy with proctectomy – remove colon, and rectum
Abdominoperineal resection – remove colon, rectum and anus (for low rectal tumors or anal tumors)

A colectomy may be performed using traditional open techniques, laparoscopically, or robotically assisted.

Colostomy or Ileostomy (Ostomy)

In surgeries for both colostomy and ileostomy, a stoma is made to the outside of the body through the abdominal wall, and an ostomy pouch is placed around the stoma to collect and remove stool. A colostomy surgery happens when a section of large intestine has been removed and the stoma is created with the colon. An ileostomy is when the entire colon is either removed and/or the colon needs to be bypassed, so it can heal after a resection. In this case, the small intestine is what forms the stoma. Both a colostomy and an ileostomy can be temporary and reversed, or permanent.

Colostomy/ileostomy Reversal Surgery

A reversal surgery is possible if the colon heals after the initial resection surgery, which could take several months. A reversal surgery (also called a “take-down”) which will remove the stoma, and waste will be eliminated through the colon and rectum again.

Low Anterior Resection (LAR)

LAR is a common surgery for treating rectal cancer. The tumor and part of the rectum are removed without affecting the anus. The colon is then attached to the remaining part of the rectum so that after the surgery, stool can exit through the anus like it did before the surgery. Sometimes a temporary ostomy is needed in LAR surgery.

Abdominoperineal Resection (APR) with Ostomy

APR is another common surgery for rectal cancer patients. One incision is made in the abdomen and another in the perineal area to remove a section of sigmoid colon, the rectum, and the anus and the tissues surrounding it, including the sphincter muscle. This is more extensive than a LAR surgery because the anus is removed. With an APR, patients receive a permanent colostomy.

What about surgeries outside of the colon or rectum?

In cases of colorectal cancer metastasis, additional surgeries on the liver, lungs, abdomen, uterus/ovaries, bladder, and brain may also be needed. It’s important to speak with your doctor about your treatment plan and course of action, and which surgeries need to come first. Your treatment plan will be unique to your case.

Many patients who will undergo intravenous treatment will also have a port-a-cath placed (also called a port).

What should take place before surgery?

Before surgery, you’ll need several tests. Some of these tests may have been what led you into surgery. Some will inform your doctors on the extent of your cancer and guide your next steps:

Colonoscopy
Biopsy of any polyps or areas of concern
Mismatch repair (MMR) or microsatellite instability (MSI) testing – performed on your tumor
Blood tests (CBC, chemistry profile, CEA level)
CT with contrast of chest, abdomen, pelvis
Additional imaging tests like MRI, PET, and endorectal ultrasounds may also be ordered

What to expect during the pre-op hospital visit

Before surgery, you will need to schedule a pre-op visit at the hospital where your surgery is taking place. The hospital should reach out to you to schedule this; however, be sure to advocate for yourself. If the hospital does not call you, call the hospital and double-check you’re on the surgery schedule and ask to set this critical appointment.

Depending on the type of surgery you have planned, the following may take place:

Labs will be drawn
Medical history intake (be sure to know your current medications and dosages)
For ostomy surgery: You should meet with an ostomy nurse who will help mark where your stoma should be placed and answer any pre-surgical questions about your ostomy.
You may also be invited to a class for education on your surgery and how to recover immediately following.

During this visit, payment may be due. When you set your pre-op- appointment, ask if any money will be due that day and/or what fees to expect.

How can I prepare for surgery?

What side effects should I expect after surgery?

Nasogastric Tube (NG Tube)

Some patients who undergo abdominal surgeries receive an NG (nasogastric) tube for a portion of their hospital stay or possibly just during surgery. This tube is often placed when you’re under anesthesia, but not always. It is inserted through a nostril and connects the stomach to an external pump, so the stomach can empty while the colon “wakes up” following surgery. Not every patient will require an NG tube following surgery. Side effects of the NG tube can include:

Chafing around the nose
Sore throat
Irritation and aggravation (Although temporary, many find this tube uncomfortable.

Pain

A surgical incision will likely leave patients feeling sore and stiff, and most patients need pain medication following surgery for several weeks following the procedure. Pain may be managed with both narcotic and non-narcotic pain medications, depending on its severity. Narcotic pain medications especially may have undesirable side effects, such as constipation, so be sure to always follow dosing instructions carefully and discuss any worrisome side effects with your care team.

Pain may occur:

Near your incision site(s)
Your shoulders and neck (This is common immediately following anesthesia.)
Headache

Nausea

Many patients may experience nausea following colorectal cancer surgery. This can be a side effect from the surgery or anesthesia, but it can also come from the pain medication and/or indicate an obstruction or ileus has formed. Make sure to tell the nurse everything you’re experiencing following surgery, so they can identify the cause of nausea and adjust your medications and/or run tests as needed.

Leakage

Some surgeries may cause infection around the scar or result in other complications. If you experience anything abnormal, both when you’re admitted to and discharged from the hospital, notify your doctor’s office immediately.

Restricted Diet

Following surgery, your diet will likely be restricted for a short period of time. Ask your doctor what to expect based on the type of surgery you undergo. Some patients are restricted to ice chips and liquid diets for a few days before resuming solid foods. For other patients who need extended periods of healing, TPN (total parenteral nutrition), which is nutrition administered via an IV, may be discussed and recommended.

Depression and Anxiety

Surgery doesn’t just impact your body physically; it can also impact your mind and emotions. It’s not easy to undergo major surgery. Being confined to a bed, restricted on movement and diet, and adjusting to new bodily functions and scars can be very challenging.

As you recover from surgery, check in with yourself regarding your mental health and emotions. Invite friends to ask you questions about how you’re doing and feeling. Be honest with the medical professionals caring for you and let them know if you’re feeling down and anxious. There are both medication and non-medication options to help you through challenges.

Learn more about mental health.

What is recovery like?

Different methods of surgery have varied recovery times. You need to be prepared. Following your surgery, you will likely want to lay low, but movement is key. Get up and walk as much as you’re able.

Your diet will progress as you recover. You will be on NPO (nothing by mouth) immediately following surgery, but you’ll progress to ice chips and clear liquids. From there, you’ll move on to full liquids, and if you tolerate those well, you’ll likely have more food choices. You’ll want to choose soft foods, and foods without fiber.

A low-residue diet will likely be advised for several weeks as you’re recovering. A low-residue diet is a diet low in fiber, which minimizes the amount of work for your colon and rectum. Think “white bread and white rice, not whole grain bread and brown rice,” and avoid foods like raw vegetables, nuts and seeds, whole grain products, beans, and fried meats.

Many patients spend most of their recovery time at home once released from the hospital. A few things to line up as you plan recovery:

Mobility around the house – make sure you have a bed and chair that you can get to easily.
Groceries – have someone stock your kitchen with foods you’ll need after surgery.
Transportation – your doctor will let you know when you’re cleared to drive after surgery. Have rides lined up until you can drive again.

What if I’m having surgery, but I don’t have cancer?

In some cases, patients choose to undergo prophylactic surgery, which is surgery to remove an organ or gland to try to stop cancer before it starts. Often, patients with a family history and/or a genetic syndrome consider prophylactic surgery.

If you’re considering this preventive surgery, work closely with your medical team to determine the risks versus rewards of having surgery, and create a plan that best fits your needs.

What if surgery isn’t an option for me?

Some patients are inoperable either because of the size/location of their tumors, it’s metastatic, and/or their health does not permit it. In this case, there are still treatment options like chemotherapy, targeted therapy, immunotherapy, and radiation therapy.

Let your doctor know your thoughts about how to proceed with treatment if surgery is not an option for you, and always consider getting a second opinion and searching for clinical trials.

Also, even if you do not undergo surgery, you’ll want to ask your doctor to perform tumor testing on a biopsy of your tumor so you can identify your biomarkers.

What will I find out after surgery?

After your surgery, you will receive information that will guide your next steps. This can include:

Pathology report with a pathological diagnosis. This will determine the pathological stage of your cancer.
MMR/MSI testing results – everyone diagnosed with colorectal cancer should have this test performed. Ask your doctor to make sure to test for this and ask for the results.
Biomarkers report – Ask your doctor to perform tumor testing for biomarkers. This is invaluable information, especially for stage IV patients. Your biomarkers will determine which treatments you will/will not be eligible for.

You will see your surgeon (or someone on their team) every day while you’re in the hospital. It’s important to attend all your follow-up visits once you’re released.

Medical Review

stent as a bridge to surgery Carmen Fong

Carmen Fong, MD, FACS

Institution/Facility Hemorrhoid Centers of America