Surgery for rectal cancer

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.
  • The cancer and some normal colon surrounding your cancer, as well as the nearby lymph nodes will be removed.

For laparoscopic surgery:

  • Your surgeon will make three to four tiny cuts 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.