Colon and Rectal Cancer Surgery: What Happens Before, During, and After the Operation

Understanding colorectal cancer surgery

Colorectal cancer surgery involves the removal of the cancerous part of the colon or rectum, along with nearby lymph nodes to check for spread. The primary goal is to remove all cancerous tissue and prevent its recurrence, thereby improving patient outcomes and quality of life.

There are several types of treatment procedures, tailored to the location, size, and stage of the cancer. These include:

• Colectomy, which essentially involves the removal of part or all of the colon. 

• Low Anterior Resection for removing the lower rectum and a portion of the sigmoid colon to treat rectal cancers, and potentially ostomy creation.

• Minimally invasive techniques, such as laparoscopic colectomy, are increasingly common for many patients.

Before the surgery (Pre-operative phase)

Thorough preparation is key to a successful outcome in colon cancer surgery. A team of skilled specialists ensures personalised care during this crucial phase. This includes:

A comprehensive medical evaluation (physical exams, blood tests, imaging)

• Nutritional assessment 

• Bowel preparation 

• A detailed medication review

• A pre-anesthetic check-up 

If an ostomy is anticipated, consultation with a specialised nurse follows

It is vital to follow all dietary and bowel prep instructions meticulously, inform the medical team about all medications, and arrange for home support. Avoidance of eating or drinking after the specified time before surgery, and refrain from smoking or consuming alcohol are important.

During the operation (Intra-operative phase)

On the day of the surgery, the patient is given general anesthesia. A skilled surgical oncology team, comprising colorectal surgeons, anesthesiologists, and nurses, work meticulously to ensure the best possible outcome. 

The cancerous section of the colon or rectum is carefully removed, along with surrounding lymph nodes. Whenever possible, the remaining healthy ends of the bowel are reconnected (anastomosis) to restore normal digestive function. If reconnection is not immediately safe or feasible, a temporary or permanent ostomy may be created.

Surgical approaches include- 

1. Open surgery which involves a single, larger incision 

2. Minimally invasive techniques including laparoscopic surgery and robotic-assisted surgery

• Laparoscopic surgery- this uses several small incisions, often leading to less pain, smaller scars, and faster recovery. 

• Robotic-assisted surgery- this offers enhanced precision and dexterity for the surgeon.

After the surgery (Post-operative phase)

The post-operative period focuses on pain management, monitoring for complications, and facilitating your return to normal activities. Hospital stays typically range from 3 to 7 days, often shorter for minimally invasive procedures. 

• The patient is closely monitored in a recovery room, with pain medication administered as needed. 

• Early mobilisation, such as walking, is strongly encouraged to prevent complications like blood clots. 

• Diet gradually progresses from clear liquids to a regular diet. 

• Detailed wound care instructions are provided. (For example, during a hemicolectomy recovery, following discharge instructions carefully is vital for optimal healing. In case of an ostomy, a stoma nurse educates the patient on its management.) 

• Before discharge, instructions on medication, diet, activity restrictions, and signs of potential complications are explained in detail. 

• Regular follow-up appointments are crucial to monitor recovery and discuss further treatment if necessary.

Benefits of colorectal cancer surgery

Undergoing colon cancer surgery offers significant advantages:

• High cure rates for early-stage cancers- It helps remove cancerous growths from the colon or rectum, reducing the spread of disease and improving the chances of successful treatment.  

• Improved survival- Early surgical intervention significantly increases survival rates, especially when colorectal cancer is diagnosed in its initial stages. 

• Relief from symptoms- Colorectal cancer surgery can reduce symptoms like abdominal pain, rectal bleeding, bowel obstruction, constipation, and discomfort caused by the tumour. 

• Reduced risk of complications- Timely surgery can prevent complications such as intestinal blockage, severe bleeding, perforation, and infection caused by tumour growth. 

• Prevention from spread of cancer- Surgery can help stop cancer from spreading to nearby lymph nodes and distant organs such as the liver or lungs. 

• Enhanced quality of life and better prognosis- By eliminating or reducing the cancer burden, patients often experience improved digestion, bowel function, and overall well-being after recovery. 

With advanced laparoscopic and robotic techniques, added benefits include:

• Improved precision

• Smaller incisions

• Minimal scarring

• Less pain

• Reduced blood loss

• Faster recovery 

• Shorter hospital stay

• Lower risk of infection

Conclusion

Colon cancer surgery plays a vital role in removing cancerous tumours from colon or rectum, preventing disease progression, and improving long-term survival and quality of life.Our multidisciplinary specialists at Manipal Hospitals provide personalised, comprehensive care with a strong focus on effective cancer treatment and preserving bowel function whenever possible. If you are experiencing symptoms of colorectal cancer or exploring treatment options, consult our experienced surgical oncology team at Manipal Hospitals Rangapani.