Colon Cancer Surgery

As with any surgical procedure you should seek out someone who is experienced and trained in the surgical management of colorectal cancer. A physician board-certified by the American Board of Colon and Rectal Surgery is someone who has additional training and education about colorectal cancer. Additionally, many General Surgeons have the experience and surgical volume of cases to be proficient and have good outcomes. Be sure to inquire as to the training, experience, current volume of cases and board certification of your surgeon.

Surgery for colon cancer involves removing the segment of colon harboring the tumor as well as the feeding blood vessels and surrounding lymphatics. It is important to remove more than just the cancer itself so as to obtain as many lymph nodes as possible (12 is considered a basic minimum standard). Surgery to remove 8-12 inches of colon is typical and usually has minimal impact upon bowel function. Some surgeons will ask you to do a bowel prep beforehand similar to that which one would do with a colonoscopy, but in many cases this is not necessary, and studies have shown surprisingly that infection risks are about equal either way.

The surgical technique involves either laparoscopic or open surgery. The ultimate outcomes and survival are equivalent with each technique, so the main decision is based on your particular case and your surgeon’s input. Laparoscopy has become the technique of choice by most surgeons and does seem to lead to quicker recovery, less pain, less scarring but most importantly comparable results compared to the traditional approach using larger incisions.

Laparoscopic colon surgery entails placing several small incisions over the abdomen allowing the placement of a camera and long slender instruments to manipulate the tissue. Usually a 3-5 inch incision is needed to remove the specimen and facilitate reconnecting the bowel. Surgery usually lasts 2-4 hours varying upon the complexity of the case, and typically requires 3-5 days to recover in the hospital.

With any colon surgery the risks include infection, bleeding or need to make larger incisions than was anticipated based upon intraoperative findings. Of particular concern for many patients is the need for a colostomy (a need to create an opening on the abdominal wall through which stool will pass into a bag).
Colostomy creation is a rarely needed nowadays. The unusual occurrence of an anastomotic leak (leakage of stool contents into the abdomen from where the bowel was reconnected) may unfortunately require such an intervention. For most colon surgery the risk is 1-2% of a leak and such a condition would usually be apparent while you are still hospitalized or shortly thereafter, and may lead to the need to re-operate to fix the problem. Anastomotic leak rates are equal between laparoscopic and open surgery.

Types of Colon Resections

Right colectomy Sigmoid colectomy Left colectomy