Understanding Colorectal Cancer: Colorectal Resection
What is a colorectal resection
A colorectal resection is a surgery to remove a section of the large intestine. This is done in order to remove diseased parts of the colon. This procedure is not just used for colorectal cancer. It is used in a variety of other diseases like Crohn’s disease, colitis, and diverticulitis. The type of resection is based on many factors including the size and location of the tumor.
Total Colectomy: A total colectomy is removal of the entire colon. This procedure is not as common for colon cancer unless there are multiple pre-cancerous polyps throughout the colon. Sometimes all or part of the rectum is also removed and this is called a proctocolectomy. Prophylatic colectomy may be done for people who have a strong family history of cancer or other bowel-related diseases like inflammatory bowel disease (IBD). These people may choose to have their colon removed when biopsies reveal a pre-cancerous condition called dysplasia.
Partial Colectomy: A partial colectomy is removal of a part of the colon with the healthy portions of the colon and rectum reconnected. This reconnection procedure is called anastomosis. Partial colectomies are more common in colon cancer and include:
- Hemicolectomy - either the right or left side of the colon is removed
- Sigmoid colectomy – the sigmoid colon is removed.
Lower Anterior Resection (LAR): A LAR is the removal of part or all of the sigmoid colon and the part of the rectum with the tumor. The remaining colon is connected to the remaining rectum. Sometimes if chemo is required, a temporary ileostomy is created.
Abdominoperineal Resection (APR): ARP is the removal of the lower part of the colon and the entire rectum and anus. A colostomy is created with this surgery.
An ostomy is a surgically created opening in the skin. The doctor brings the colon or small intestine to the surface of the belly through the new opening so the body can get rid of stool. The name of the ostomy indicates its location: colostomy (colon) and ileostomy (ileum in the small intestine).
For more information on ostomies, visit Ostomy Basics.
How to prepare for a colorectal resection
The doctor may ask you to stop taking some medicines up to one week before the procedure. Usually these are drugs that can lead to excess bleeding, like aspirin or blood thinners.
You should also prepare by drinking eight 8-ounce glasses of fluid every day. You may require a special diet for several days before surgery. The colon must be cleaned out before the surgery. Your doctor may ask you to take an enema or laxatives. You may have to drink a large container of solution. This preparation may start several days before the procedure. It’s not a fun process, but also not painful.
It’s important to arrange for a ride to and from the hospital. You may need help at home for the first few days after the procedure.
What to expect during the procedure
You will be given general anesthesia so you will be asleep during the procedure. The surgery can be done with either a traditional open surgery or with a minimally invasive surgery. With an open procedure the surgeon makes a long incision (cut) down your belly to do the surgery. In minimally invasive surgery the surgeon makes a few small cuts instead of a large cut in the belly. Minimally invasive surgeries include laparoscopic and robotic assisted surgeries. Not everyone is a candidate for these types of surgeries. Ask your doctor which type of procedure is right for you.
During the procedure, the diseased section of the intestine is removed. The two loose ends of intestine are then sewn together. The surgeon may leave some soft tubes in the abdomen. These let any fluids drain.
If the doctor thinks the intestines need time to rest and heal, he or she may perform a colostomy or ileostomy, sometimes referred to as an ostomy. In this procedure, the surgeon brings the colon or small intestine onto the abdomen wall. This opening is called a stoma. One or both ends of the intestine are attached to the stoma. Waste material (feces) leave the intestine through the stoma and collect in a bag called an ostomy pouch.
The doctor may leave the ostomy in place for several months as the intestines heal. When that healing has happened, the ends of the intestine will be joined together.
A colorectal resection takes between one and four hours. Your doctor will tell you how long you are expected to be in the hospital after your surgery.
What to expect after the procedure
The doctor may prescribe antibiotics. You may also need medicine for nausea and pain. Some patients require a nasogastric (NG) tube for a few days. This tube enters through the nose and goes to the stomach. This helps decompress the bowel.
The intestine will need some time to heal before it can function properly again. At first you will receive fluid through an IV (needle in a vein such as in the hand). You will need to be on liquid and soft diets as you get better. Eventually you will work your way back to a regular diet.
If you had a colostomy or ileostomy there will be a bag called a pouch attached on the outside of your body. Waste material (feces) will collect in it. You will have special instructions about diet and activity. For the first few days after surgery, you may be restricted from eating.
It is normal to take some time to adjust to an ostomy. Your doctor can help you find a support group in your area as well as arrange home health care.