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Surgical Treatment for CRC: The Colon Resection Surgery

Once colon cancer has been diagnosed, surgery is normally required to remove the cancerous polyps and/or other malignant tissue. The type of surgery and adjuvant (follow-up or additional) treatment used depend largely on the stage of the cancer and how far the disease has spread.

Surgery involves removal of the malignant tumor along with part of the healthy colon or rectum and local lymph nodes.

In the earliest stages, pre-cancerous polyps or cancerous lesions can be removed easily by means of colonoscopy, whereby a flexible camera is inserted through the rectum and the suspect tissue removed using a special tube.

Following surgical removal (resection) of larger areas of colorectal malignancies, including Stage II and III cancers, an attempt is made to reconnect healthy sections of the colon whenever possible.

In cases where the surgeon is unable to reconnect healthy sections of the colon, a temporary or permanent colostomy may be necessary. Currently, around fifteen percent of all patients undergoing surgery for CRC require a permanent colostomy.

Research Says . . .

If surgery alone is performed, without adjuvant therapy, such as chemotherapy, radiotherapy or immunotherapy, recurrence rates for CRC may be as high as thirty to sixty percent for Stage III tumors.

What is a Colostomy?

Colostomy is a by-pass surgical procedure that makes an opening, called a stoma, in the abdomen through which a small portion of the colon is re-directed to the surface of the skin. This enables waste products to pass directly from the body.

After colostomy surgery, the stool passes through the stoma and empties directly into a pouch or bag. With a colostomy, the patient no longer has voluntary control over bowel movements.

The four common types of colostomies are:

Ascending colostomy
Transverse colostomy
Sigmoid colostomy
Descending colostomy.

Laparoscopy

Unlike conventional operations that require a major abdominal incision and a lengthy recovery period, laparoscopy involves making about three to five small "keyhole" incisions (typically less than a quarter of an inch across). Laparoscopy is performed under general anesthesia.

Laparoscopies are not suitable for all patients. Conditions such as obesity, advanced kidney, lung or heart disease, or previous cancer or abdominal surgeries may influence the surgeon's decision as to whether a patient is eligible or not.

Possible Side Effects

Both conventional and newer colorectal surgery procedures may cause temporary pain and tenderness in the area of the operation. Recovery, however, is much faster following minimally invasive techniques, such as laparoscopy.

Colostomy patients may also experience some localized irritation of the skin around the stoma.

Temporary constipation or diarrhea for a few days after colorectal cancer surgery is not uncommon.

Possible Complications

As with any surgical procedure, complications may arise, including:

an adverse reaction to general anesthesia
abdominal bleeding
blood clots in the legs with migration to the lungs
an internal or external infection
obstruction of the large intestine caused by scar tissue
bowel leakage
a possible heart attack
pneumonia
injury to other organs.

New Developments

Advanced technologies and new developments in colorectal surgery have resulted in the availability of several new surgical options for patients with CRC.

The George Washington University Hospital, Washington, D.C., for example, performs routine CRC surgery and also provides both colorectal laparoscopy and trans-anal endoscopic microsurgery. Both of the minimally invasive procedures are proving highly effective at removing polyps and cancerous tissue from the colon and rectum, while at the same time maintaining normal functioning of the large intestine.

Today's refined surgical methods for reconnecting the healthy sections of the colon and rectum also mean that the majority of patients no longer require a colostomy.

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