Colon and Rectal Cancers - Surgery

Highlights	Prevention	Radiation Treatment
Introduction	Diagnosis	Follow-up Testing
Causes	Staging	Treatment for Metastasized Colorectal Cancer
Symptoms	Prognosis	Resources
Risk Factors	Surgery	References
Dietary Factors	Medications

Surgery

Surgical removal of the tumor ("resection") along with any affected surrounding tissue is the standard initial treatment for potentially curable colorectal cancers (cancers that have not spread beyond the colon or lymph nodes). Drug therapy, radiation, or both are often used for advanced cancers and are continuously being tested with surgery in different combinations and sequences.

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Although choosing a qualified surgeon is critical, choosing a hospital experienced in procedures is also important. The more often colon cancer surgery is performed at a given hospital, the lower the mortality rate at that hospital is likely to be. In one 2000 study, the 30-day postoperative mortality rate for patients treated at hospitals in the top quartile of procedure volume was 3.5%. For hospitals in the bottom quartile, mortality was 5.5%. However, the differences were small, and significantly less than seen for more complex cancer surgeries.

Colectomy

Unless cancer is very advanced, most tumors are removed by an operation known as colectomy:

Colectomy involves removing the cancerous part of the colon and nearby lymph nodes.
The surgeon then reconnects the intestine by a procedure known as anastomosis.
If the surgeon cannot reconnect the intestine, usually because of infection or obstruction, a colostomy is performed. The need for colostomies is higher after surgery for rectal cancer. In most cases of colon cancer, colostomies are not needed.

Click the icon to see an illustrated series detailing colon cancer treatment.

The Surgical Approach. The standard technique for a colectomy is open, invasive surgery. Laparoscopy, sometimes called ?keyhole surgery? is a less invasive method. Laparoscopy is still considered an investigational technique for treating colon cancer, but it is gaining more acceptance and showing good results in clinical trials.

Open Surgery:

Opensurgeryuses a wide incision to open up the patient's abdomen. The surgeon then performs the procedures with standard surgical instruments. This is the usual method for performing colectomy.

Laparoscopy:

Laparoscopy uses a few small incisions through which the surgeon passes a fiber optic tube (laparoscope) containing a small camera or tiny instruments. It is generally used for early colon cancer (for tumors less than 2 centimeters or for well-defined tumors less than 3 centimeters).
A 2004 study published in the New England Journal of Medicine found that patients who received laparoscopic colectomy had similar rates of surgical complications, cancer recurrence, and survival as those who received traditional open surgery. However, the patients who had laparoscopy recovered faster and did not need as many narcotic painkillers.
Several 2005 studies indicated that laparoscopy works as well as conventional surgery for treatment of colon cancer. However, laparoscopy does not appear to be as effective for rectal cancer.