Laparoscopic Colon and Rectal (colorectal) cancer

WHAT IS THE TREATMENT FOR COLORECTAL CANCER?

Surgery for colorectal is the main mode of treatment for colorectal of all stages. Surgery works by removing the part of your colon or rectum which contains the cancer and the regional lymph nodes.
In rare cases, your entire colon may have to be removed.

The two ends of the sections being cut are then connected. Should there be a case where your colon is not able to be connected, an artificial opening for the colon, which is known as a colostomy, may be needed. This opening works by allowing waste materials to be excreted from your body if it is not able to be removed from the normal opening of your colon. The colostomy may be temporary, and the ends of your colon may be reconnected when your colon has healed.

In other cases, the colostomy is permanent.

In more advanced stages of colorectal cancer, surgery will be performed on other organs to which the cancer has spread to remove the cancer. Surgery may also be performed as a form of palliative treatment to ease the pain, discomfort and other symptoms you may experience.
Palliative surgery aims to improve your quality of life.

After surgery has been carried out to remove as much of the cancer as possible, chemotherapy and/or radiotherapy may be required to kill any cancer cells that are still in your body. These increase the chances that you are fully cured from colorectal cancer and lowers the possibility of the cancer returning. Chemotherapy refers to the injection of anti-cancer medications into a vein on your hand. Radiotherapy refers to the use of high energy X-rays, electron beams or radioactive isotopes to attack your cancer cells. A machine is used to deliver this radiation to targeted cancer cells in your body to stop the growth of cancer cells.

What are the types of surgery for colorectal cancer?

A local excision is used for very early stages of colorectal cancer. Instead of cutting through your abdominal wall, your surgeon removes the cancer by using a tube with a cutting tool through the rectum into your colon. This is used to remove the cancer. If the cancer is found in a polyp, which is a mass of cells found on the lining of your colon, a polypectomy is carried out whereby the polyp is removed.

If the cancer is found at later stages where the tumour has grown bigger, resection of your colon is performed. This is known as a colectomy, where your surgeon removes the cancer and a small amount of healthy tissue nearby. Your lymph nodes near the cancer site will likely be removed to test for cancer. Thereafter, anastomosis may be carried out where the healthy segments of your colon are rejoined. Otherwise, a stoma (opening) will be created on the outside of your body in a procedure known as a colostomy. A colostomy bag is attached to the stoma. This allows waste materials to pass through and be removed from your digestive system. In certain cases, colostomy may be reversed once your lower colon has healed. In cases where your entire lower colon has to be removed, the colostomy may be permanent.

Why surgery for colorectal cancer?

Surgery is the main mode for treatment for colorectal cancer of all stages, as this is highly effective in removing the cancer cells. Removal of cancer cells reduces the possibility of the cancer progressing and spreading to other parts of your body. The type of surgery carried out depends on the stage of colorectal cancer.

What to expect?

Before the procedure

  • Stop taking current medications as instructed by your doctor as certain medications may increase your risk of complications during surgery.
  • Avoid smoking and alcohol so that you may recover in a shorter time.
  • You will be given bowel preparation to clear your bowels. This helps to empty your colon prior to the surgery.
  • You may be prescribed antibiotics a few days before the procedure to prevent an infection. Your colon contains bacteria that may leak into your abdomen during surgery, and antibiotics reduce the risk of infection.
  • You may be put on a soft diet or liquid diet two to three days before the procedure.
  • Fast as instructed by your doctor.

During the procedure

  • You will be given anaesthesia to help you fall asleep during the procedure.
  • The surgery may be performed via open surgery or laparoscopic surgery.
  • In open surgery:
    A single larger incision is made in your abdomen.
    Your surgeon accesses your colon through this incision.
    Surgical tools are used to separate your colon from nearby tissue and cut out a segment of your colon or the entire colon.
  • In laparoscopic surgery:
    Several small incisions are made in your abdomen.
    A tiny camera is placed through one of the incisions. Your surgeon watches the video screen in the operating room to view your internal organs. This aids him in using the tools to operate on your colon.
    Special surgical tools are placed through the other incisions.
    Your colon is temporarily removed through an incision and repairs are made before reinserting it back into your body.

After the procedure

  • You will be taken to a recovery room to be monitored by the nurses as the anaesthesia wears off.
  • You may have liquid nutrition inserted through a vein in your arm and then consume a liquid diet.
  • You may gradually add soft foods and solid foods into your diet as your colon recovers.
  • You will be shown how to care for your stoma and change your ostomy bag (to collect waste) by a nurse had you undergone a colostomy.
  • You may be discharged within a few days to a week. This happens once you are able to drink the required liquids without feeling unwell, regain bowel function, move around without assistance and the pain is under control with painkillers.
  • You may have to rest at home for a few weeks to recover. You may get tired easily and have a reduced appetite. This is normal and will go away as your body heals and and your strength returns.
  • Your bowel movements may not be as regular for some time and will return to normal with time.

Why Surgery For Rectal Cancer

Surgery is the main mode for treatment for rectal cancer of all stages, as this is highly effective in removing the cancer cells. Removal of cancer cells reduces the possibility of the cancer progressing and spreading to other parts of your body. The type of surgery carried out depends on the stage of rectal cancer.

What is the treatment for each stage of rectal cancer?

In Stages 0 and some cases of Stage I rectal cancer, the polyp may be removed completely via polypectomy. Polypectomy is usually done during a colonoscopy, where the polyp is removed through the anus and the abdomen does not need to be cut.

In other cases of Stage I rectal cancer, where the cancer has grown into the inner lining of the rectum, and Stage 2 rectal cancer, a small amount of the surrounding tissue which contains the cancer is also removed. This may be done using transanal resection or transanal endoscopic microsurgery (TEM). In other cases, a low anterior resection (LAR), proctectomy with colo-anal anastomosis, or an abdominoperineal resection (APR) may be done. Chemotherapy and radiotherapy is recommended along with surgery for Stage 2 rectal cancer. These work by stopping the growth of new cancer cells and making the tumour smaller in size.

In Stage 3 rectal cancer, surgery is performed to remove the rectal tumour and nearby lymph nodes. This may be done using LAR, proctectomy with colo-anal anastomosis, or an APR.Chemotherapy and radiotherapy is recommended along with surgery.

If the cancer is at an advanced stage where it has spread to other organs in your body such as the liver or lungs, the primary cancer in your rectum will first be removed. Thereafter, your surgeon will perform surgical removal of the cancer in the other organs. These can be done via the LAR or APR. Depending on the extent of the cancer, surgery will help you live longer or may cure you.

After the respective sections of your rectum is removed, the two open ends of your bowel is rejoined. Otherwise, a temporary stoma which is an opening will be in place. A bowel bag is placed over the stoma to collect bowel motions and let your bowel rest after the surgery.

What to expect?

Before the procedure

  • Stop all current medications you are on as instructed by your doctor.
  • Do not smoke or drink alcohol 24 hours prior to the procedure.
  • Fast as instructed.
  • You will be given bowel preparation to take the night before your procedure.

During the procedure

  • You will be given anaesthesia to help you fall asleep.
  • The nurses will clean your abdomen with antibacterial soap and use sterile drapes to cover you.

For open surgery:

  • Your surgeon will make an incision in your abdomen.
  • He or she will insert a narrow telescope with a camera attached and other instruments through the cuts. This is to remove the section of your bowel with the tumour.
  • Most of the operation is performed through the small cuts, though a slightly larger opening is required to remove the portion of bowel from your body.
  • After the cancer has been removed, your surgeon may perform an anastomosis, where healthy parts of the rectum are rejoined, or a colostomy, where a stoma opening is created for waste to pass through. A bag is placed around the stoma to collect the waste.

After the procedure

  • You will be administered pain medications through the epidural catheter, through IV or oral medications.
  • You may consume a liquid diet soon after your surgery. This is to enable your bowel to recuperate.
  • You may gradually consume solid foods two to three days after the surgery. Eat small and frequent meals.
  • You will be assisted to spend more time out of bed by the physical rehabilitation team. This is to promote rehabilitation and proper functioning of your rectum.
  • You may be discharged two days after the surgery.
  • Continue the diet recommended by your doctor at home.
  • Schedule a follow-up appointment with your doctor one to two weeks after the surgery.