Colorectal Cancer Surgery

A polypectomy 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. You may not even be aware that you’ve had a polypectomy until your physician tells you!

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.

A colectomy is a procedure, which removes a section of the colon that contains the cancer, as well as nearby lymph nodes. After the cancerous part of the colon is removed (resection), the two ends of the remaining colon are reattached (anastomosis) to eliminate waste through the rectum. This procedure is also referred to as:

• Hemicolectomy
• Partial Colectomy
• Segmental Resection

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

A colostomy 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 through the abdominal wall, 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 on the outside of the abdominal wall for waste
• Stoma: the actual end of the intestine seen peeking through the abdominal wall

A reversal surgery is possible if the colon heals after the initial resection surgery, which could take as long as several months. A reverse colostomy surgery (colostomy take-down) is performed since the stoma will no longer be necessary.

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.

APR is another 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 more extensive than a LAR surgery because the anus is removed. With an APR, patients receive a permanent colostomy.

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 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. Not every patient will require an NG tube 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

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.

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. 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.

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

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 administered via an IV, may be discussed and recommended.