Surgery for Rectal Cancer

Surgery is a common treatment for rectal cancer, and the goal of surgery is to remove the tumor and any affected tissue. The type of surgery used depends on the stage and location of the cancer.

Types of Surgery

• Low Anterior Resection (LAR): This is a surgical procedure that involves removing the part of the rectum where the tumor is located, as well as a portion of the sigmoid colon. The remaining rectum is then reattached to the colon.
• Abdominoperineal Resection (APR): This surgery involves removing the entire rectum, anus, and part of the sigmoid colon. A permanent colostomy is created, which requires a bag to collect stool.
• Pelvic Exenteration: This is a more extensive surgery that involves removing the rectum, anus, bladder, and other surrounding tissues. This type of surgery is typically used for advanced cancer that has spread to other areas.
• Transanal Endoscopic Microsurgery (TEM): This is a minimally invasive procedure that uses an endoscope to remove small tumors from the rectum.
• Laparoscopic Surgery: This type of surgery uses small incisions and a laparoscope to remove the tumor. Laparoscopic surgery can be used for LAR or APR procedures.
• Robotic-Assisted Surgery: This type of surgery uses a robotic system to assist with the removal of the tumor. Robotic-assisted surgery can be used for LAR or APR procedures.

Pre-Surgical Preparation

Before undergoing surgery, patients typically undergo a series of tests and preparations, including:

• Blood work to check for anemia and other conditions
• Imaging tests such as CT scans or MRI scans to determine the extent of the cancer
• Bowel preparation to clean out the rectum and colon
• Meeting with a dietitian to discuss post-surgical nutrition
• Stopping certain medications, such as blood thinners, before surgery

Surgical Procedure

The surgical procedure typically involves:

• General anesthesia to put the patient to sleep
• A midline incision in the abdomen to access the rectum and colon
• Removal of the tumor and affected tissue
• Reattachment of the remaining rectum or creation of a colostomy
• Closure of the incision site

Post-Surgical Care

After surgery, patients typically require:

• Pain management with medication
• Bowel rest to allow the rectum and colon to heal
• Nutritional support through IV fluids or a feeding tube
• Monitoring for complications such as infection, bleeding, or bowel obstruction
• Follow-up appointments with the surgeon to check on healing progress

Risks and Complications

Surgery for rectal cancer carries risks and potential complications, including:

• Bleeding or hemorrhage
• Infection
• Bowel obstruction or blockage
• Urinary retention or incontinence
• Sexual dysfunction
• Nerve damage or numbness

Recovery and Follow-Up

Recovery from surgery for rectal cancer can take several weeks to months. Patients typically require:

• Follow-up appointments with the surgeon to check on healing progress
• Adjuvant therapy, such as chemotherapy or radiation, to treat any remaining cancer cells
• Lifestyle modifications, such as dietary changes and exercise, to promote overall health
• Regular screening for recurrence or metastasis