Surgical Techniques for Colon and Rectal Cancer
The Toronto Colorectal Surgery Program uses a number of surgical techniques. This page will explain each of them and talk through what the techniques are, why one might be used, recovery time, and the risks and benefits of each.
Right Hemicolectomy
What is it?
In a right hemicolectomy, the intestine is removed from the last part of the small intestine to the middle of the large intestine (approximately 12-18 inches, or 30-40 centimetres), leaving more than 70% of the colon for normal function. After removal of this section of intestine, the last part of the small intestine is attached to the remaining large intestine. If this is done using a minimally invasive method, you will probably have a larger (1 cm) incision around your navel and 3-4 additional smaller incisions (½ – 1 cm) around your abdomen, as well as a small horizontal incision just above your pubic bone.
How long does it take?
This operation usually takes 2-3 hours to complete, but the entire process from entering the hospital to waking up in the recovery room will take longer.
How long does it take to recover afterwards?
Everyone is different, but patients usually take 1-2 days in hospital to recover after this operation. Your main limitation after surgery is that you should not lift anything weighing more than 10-15 lbs. (4.5-7 kg) for 4 weeks. After you get home, you will likely need at least 3-4 weeks off of work.
What are the risks? What are the benefits?
If this procedure is done using the minimally invasive method, there is always the risk that your surgeon will need to make a bigger incision and do the operation using an open method. This is usually done if the surgeon believes that it is safer to do the operation open than using a minimally invasive method. In addition, anytime the skin is cut, there is a chance of bleeding (though this is usually easily stopped using advanced surgical tools) and a chance of infection (you receive antibiotics before the operation to minimize this risk). Finally, there is a risk of injury to organs and tissues nearby the colon. If such an injury occurs, your surgeon will make sure it is fixed. It is unlikely in these operations that you will require a stoma.
Left Hemicolectomy
What is it?
In a left hemicolectomy, a segment of the left side of the large intestine is removed, based on the location of the tumour (approximately 12-18 inches, or 30-40 centimetres), leaving more than 70% of the colon for normal function. After removal of this section of intestine, the last part of the large intestine is attached to the rectum. If this is done using a minimally invasive method, you will probably have a larger (1 cm) incision around your navel and 3-4 additional smaller incisions (½ – 1 cm) around your abdomen, as well as a small horizontal incision just above your pubic bone.
How long does it take?
This operation usually takes 3-4 hours to complete, but the entire process from entering the hospital to waking up in the recovery room will take longer.
How long does it take to recover afterwards?
Everyone is different, but patients usually take 2-3 days in hospital to recover after this operation. Your main limitation after surgery is that you should not lift anything weighing more than 10-15 lbs. (4.5-7 kg) for 4 weeks. After you get home, you will likely need at least 3-4 weeks off of work.
What are the risks? What are the benefits?
If this procedure is done using the minimally invasive method, there is always the risk that your surgeon will need to make a bigger incision and do the operation using an open method. This is usually done if the surgeon believes that it is safer to do the operation open than using a minimally invasive method. In addition, anytime the skin is cut, there is a chance of bleeding (though this is usually easily stopped using advanced surgical tools) and a chance of infection (you receive antibiotics before the operation to minimize this risk). Finally, there is a risk of injury to organs and tissues nearby the colon. If such an injury occurs, your surgeon will make sure it is fixed. It is unlikely that you will require a stoma.
Total Colectomy
What is it?
A total colectomy is the removal of the entire colon, starting from the last part of the small intestine up until the top of the rectum. This is often performed for the treatment of multiple simultaneous colon cancers, or in cases where there are a large number of polyps throughout the colon which pose a risk of future malignancy and cannot be removed with a colonoscopy. The ultimate goal for most patients is to eventually connect the small intestine to the rectum, but you may require a temporary or permanent stoma. If this operation is done using a minimally invasive method, you will probably have a larger (1 cm) incision around your navel and 3-4 additional incisions (½ – 1 cm) around your abdomen, as well as a small horizontal incision just above your pubic bone.
How long does it take?
This operation usually takes 3-5 hours to complete, but the entire process from entering the hospital to waking up in the recovery room may take longer.
How long does it take to recover afterwards?
Everyone is different, but patients usually take 3-4 days in hospital to recover after this operation. Your main limitation after surgery is that you should not lift anything weighing more than 10-15 lbs. (4.5-7 kg) for 4 weeks. After you get home, you will likely need at least 3-4 weeks off of work.
What are the risks? What are the benefits?
If this procedure is done using the minimally invasive method, there is always the risk that your surgeon will need to make a bigger incision and do the operation using an open method. This is usually done if the surgeon believes that it is safer to do the operation open than using a minimally invasive method. In addition, anytime the skin is cut, there is a chance of bleeding (though this is usually easily stopped using advanced surgical tools) and a chance of infection (you receive antibiotics before the operation to minimize this risk). Finally, there is a risk of injury to organs and tissues nearby the colon. If such an injury occurs, your surgeon will make sure it is fixed. In rare cases, you may require a temporary or permanent stoma.
Following this operation, patients can expect to have more frequent bowel movements than usual since the entire colon is removed. Patients who have undergone a total colectomy can expect to have 4-9 bowel movements per day. Your surgical team will work with you to optimize your bowel routine with various dietary and medication regimens.
Low Anterior Resection (LAR)
What is it?
A low anterior resection is an operation usually performed for cancer of rectum or last portion of the sigmoid colon. Usually, the remaining rectum is connected to the end of the sigmoid colon, and you may or may not have a portion of small intestine connected to the skin of the abdomen to form an ileostomy (see temporary ileostomy section). If this operation is done using a minimally invasive method you will probably have a larger (1 cm) incision around your navel and 3-4 additional incisions (½ – 1 cm) around your lower abdomen, as well as a small horizontal incision just above your pubic bone.
How long does it take?
This operation usually takes 3-5 hours to complete, but the entire process from entering the hospital to waking up in the recovery room will take longer.
How long does it take to recover afterwards?
Everyone is different, but patients usually take 3-4 days in hospital to recover after this operation. Your stay in hospital may be extended by 1-2 days to ensure that you are comfortable managing a stoma. Your main limitation after surgery is that you should not lift anything weighing more than 10-15 lbs. (4.5-7 kg) for 4 weeks. After you get home, you will likely need at least 3-4 weeks off of work.
What are the risks? What are the benefits?
If this procedure is done using the minimally invasive method, there is always the risk that your surgeon will need to make a bigger incision and do the operation using an open method. This is usually done if the surgeon believes that it is safer to do the operation open than using a minimally invasive method. In addition, anytime the skin is cut, there is a chance of bleeding (though this is usually easily stopped using advanced surgical tools) and a chance of infection (you receive antibiotics before the operation to minimize this risk). Finally, there is a risk of injury to organs and tissues nearby the colon. If such an injury occurs, your surgeon will make sure it is fixed. In rare cases, you may require a temporary or permanent stoma.
Abdominal-Perineal Resection (APR)
What is it?
An abdominal-perineal resection is an operation usually performed for diseases of the mid-low rectum. This operation typically removes the last part of the sigmoid colon, the entire rectum, and the anus, including the anal sphincters. The end of the sigmoid colon is then connected to skin of the abdomen to form a colostomy (see colostomy section). This operation has two areas on your body where surgeons operate: (1) on your abdomen, to access the upper part of the rectum, and (2) on your perineum (area around the anus), to access the anal sphincters and lower part of the rectum. Often this operation is performed by two teams of surgeons – one team working on the abdomen side, and a second team working on the perineal side. The abdominal part of the operation can be performed with either a minimally invasive method or an open method, but the perineal part of the operation is always the same.
How long does it take?
This operation usually takes 4-5 hours to complete, but the entire process from entering the hospital to waking up in the recovery room will take longer.
How long does it take to recover afterwards?
Everyone is different, but patients usually take 4-5 days in hospital to recover after the operation. Your stay in hospital may be extended by 1-2 days to ensure that you are comfortable managing a stoma. Your main limitation after surgery is that you should not lift anything weighing more than 10-15 lbs. (4.5-7 kg) for 4 weeks. After you get home, you will likely need at least 3-4 weeks off of work.
Some procedures require the plastic surgery team to reconstruct the skin and tissue of the perineum. The limitations of this component of the surgery will be explained by the plastic surgery specialists.
What are the risks? What are the benefits?
If this procedure is done using the minimally invasive method, there is always the risk that your surgeon will need to make a bigger incision and do the operation using an open method. This is usually done if the surgeon believes that it is safer to do the operation open than using a minimally invasive method. In addition, anytime the skin is cut, there is a chance of bleeding (though this is usually easily stopped using advanced surgical tools) and a chance of infection (you receive antibiotics before the operation to minimize this risk). Because you will have surgery performed on both your abdomen and your perineum, each of these incisions carries a risk of infection. Finally, there is a risk of injury to organs and tissues nearby the colon. If such an injury occurs, your surgeon will make sure it is fixed. You will require a permanent stoma.
Trans-Anal Minimally Invasive Surgery (TAMIS)
What is it?
Trans-anal minimally invasive surgery (TAMIS) is an operation that allows your surgeon to remove lesions or tumours from the lower to middle part of your rectum by using a camera and instruments inserted through the anus. In this operation, specialized equipment is used to inflate your rectum with carbon dioxide (CO2) and a camera, and long, thin instruments are inserted into the rectum. The operation is then performed by carefully cutting out the lesion from the wall of the rectum.
How long does it take?
This operation usually takes 30-60 minutes to complete, but the entire process from entering the hospital to waking up in the recovery room will take longer.
How long does it take to recover afterwards?
Everyone is different, but patients are usually able to go home the day of, or day after their operation. After you get home, you will likely need at least 1 week off of work.
What are the risks? What are the benefits?
The risk of this approach is that some cancer cells may be left behind; your surgical team will monitor you closely after the procedure. Your surgeon will only recommend this procedure for you if they believe that they can safely remove the entire cancer through TAMIS. The benefit of this approach is that it avoids any visible incisions as all cuts are made through the anus, and that the recovery time is very fast.
Illeostomy Reversal Surgery
What is it?
If you had undergone surgery for colorectal cancer or other conditions affecting the lower digestive tract, an ileostomy may have been created to keep stool away from the affected area. Once healing has occurred and your surgical team determines that it is safe, the ileostomy can be reversed to restore bowel function a few months after your initial surgery.