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. There are different approaches to colorectal cancer surgery depending on if you have colon cancer or rectal cancer. 

Surgery for Colon Cancer

If you’ve been diagnosed with colon cancer, your first treatment step may be surgery to remove the primary tumor. A polypectomy or local excision may take place for the earliest-stage cancers (stage 0 and 1), which removes a cancerous polyp from the body without an abdominal incision. Later-staged cancers may require open or laparoscopic surgeries.

Surgery for Rectal Cancer

If you have been diagnosed with rectal cancer, you may be treated with radiation and chemotherapy prior to having surgery. It’s critical to discuss all of your surgical options and determine the goals of your treatment and surgery alongside your doctor. 

Types of Colorectal Cancer Surgery 

Polypectomy

This is most often performed during a colonoscopy and occurs when a doctor removes a polyp containing cancer 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. 

Local Excision

Local excision is also considered a colorectal cancer surgery and billed as such. It it does not require an abdominal incision and, like the polypectomy, is done by a colonoscope tool. 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 stage. 

Colectomy

Removes the cancerous part of the colon and nearby lymph nodes. After the cancerous part of the colon is removed (called a resection), the two ends of the remaining colon are reattached to eliminate waste through the rectum. This procedure is also referred to as:

• Hemicolectomy
• Partial Colectomy
• Segmental Resection

Open Colectomy

A vertical incision is made down the abdomen, surgery is performed through the opening, and the incision is closed with sutures and/or staples.

Laparoscopic Colectomy

Three small incisions are made in the abdomen so the surgeon can insert a lighted surgical instrument designed to be manipulated within the abdomen. Sometimes an incision is made just long enough for the surgeon’s hand to assist during laparoscopy. This is a less-invasive option.

Colostomy (Ostomy)

Creates a way for stool to be removed from the body when the colon cannot function properly. In this procedure, a stoma (opening) is made to the outside of the body and an ostomy pouch is placed around the stoma to collect and remove waste. A colostomy can be temporary and reversed, or it can be permanent.

• Ostomy: the opening in the body for waste
• Stoma: the actual end of the intestine seen peeking through the abdominal wall

Temporary Ostomy and Reversal Surgery

This surgery is possible if the colon can heal after the initial resection surgery (could take months to years). A reverse colostomy surgery (colostomy take-down) is performed so the stoma will no longer be necessary.

Low Anterior Resection (LAR)

LAR is a common surgery for treating rectal cancer. The tumor and part of the rectum is 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 does before the surgery.  Sometimes a temporary colostomy is needed.

Abdominoperineal Resection (APR) with Ostomy

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

What to Expect Before Surgery

• Your blood counts will be measured
• Your blood chemistry and CEA levels will be evaluated
• You will have a CT scan of the chest, abdomen, and pelvis, or a PET scan, to determine exactly where the cancer is located
• For rectal cancer, you may have an MRI and/or an endorectal ultrasound

These tests are often done after surgery to compare results.

Colorectal Cancer Surgery Side Effects

Your side effects will depend on the type of surgery you undergo. Surgeries that don’t involve abdominal incisions may result in few disruptive side effects. The doctor who performs your surgery will explain what to expect and reasons to call the doctor following your procedure.

For surgeries that involve incisions, side effects, length of hospital stay, and recovery times will depend on the type of surgery you had and how your body reacts following the procedure. 

NG Tube

Many patients who undergo abdominal surgeries receive an NG tube for a portion of their hospital stay. This tube is most often placed when you’re under anesthesia. 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. Side effects of the NG tube can include:

• Chaffing 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.

Nausea

Many patients may experience nausea following colorectal cancer surgery. This can be a side effect from the surgery, but it can also come from the pain medication. Make sure to tell the nurse everything you’re experiencing following surgery so they can identify the cause of nausea and make adjustments or run tests as needed.

Leakage

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

Diet

Following surgery, your diet will likely be restricted. 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, nutrition called “TPN” may be discussed and suggested.

More About Colorectal Cancer Surgery 

For more information, peruse the Fight CRC Resource Library for a number of additional resources, and the Fight CRC blog for stories from survivors who’ve undergone several of these colorectal cancer surgeries.

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