Surgery for Colorectal Cancer

For cancer that has spread beyond a polyp and into the colon wall, doctors can perform a partial colectomy, in which the cancerous portion of the colon is removed along with some nearby healthy tissue. They also remove surrounding lymph nodes, small immune system glands that filter out harmful substances. Lymph nodes are often the first sites to which cancer spreads.

After the section of colon is removed, surgeons reconnect the healthy portions of the bowel to restore digestive function.

The type of colectomy your surgeon performs depends on where the cancer is located in the colon.

Left and Right Hemicolectomy

When doctors find cancer in the ascending colon, the portion that runs up the right side of the lower abdomen, they perform a procedure called a right hemicolectomy. During this procedure, doctors remove the ascending colon and the cecum, which connects the colon to the small intestine. After the ascending colon is removed, the remaining healthy portion of the colon is connected to the small intestine.

For a procedure called a left hemicolectomy, doctors remove the descending colon, which runs down the left side of the abdomen. During both of these procedures, doctors reattach the remaining healthy portions of the colon to restore digestive function.

Colostomy and Stoma

Occasionally, people who have a colectomy need a colostomy, a procedure in which doctors create an opening in the abdomen, called a stoma. The stoma connects to the end of the colon and allows waste to exit the body. After a colostomy, people wear a special bag to collect body waste, which needs to be changed every day or every few days, depending on the system you use.

Our doctors and nurses at NYU Langone’s Rusk Rehabilitation can help you learn how to care for the stoma and adapt to emptying and changing a colostomy bag.

Doctors may perform a temporary colostomy when the large intestine needs time to heal after a partial colectomy. After the intestine heals, surgeons can reconnect the healthy ends of the colon.

If a person has rectal cancer, and the entire rectum and anus must be removed, a colostomy may need to be permanent. Surgeons at Perlmutter Cancer Center are highly specialized in treating rectal cancer and perform a large number of “sphincter-sparing” procedures, meaning the anus can often be preserved for bowel function, which helps most people to avoid a permanent colostomy.

A partial colectomy requires general anesthesia. Doctors may perform open surgery or use minimally invasive techniques, in which they make small incisions to help decrease bleeding, scarring, and recovery time.

Open Partial Colectomy

For an open partial colectomy, surgeons make a traditional incision in the abdomen to remove the portion of the cancerous colon. An open approach may be necessary if the abdomen contains scar tissue from a previous surgery or if the surgeon must remove larger, more complex tumors.

Laparoscopic Partial Colectomy

With laparoscopic surgery, doctors make several small incisions in the abdomen. They place a laparoscope, a tube with a tiny camera at the tip, through one incision. The camera allows for excellent visualization of the colon and surrounding organs. The doctors then insert small surgical tools into the remaining incisions to perform the partial colectomy.

Robotic-Assisted Surgery for Partial Colectomy

Robotic surgery is now one of the most common treatments to remove colorectal cancer tumors. Our doctors may use an advanced surgical system to perform a partial colectomy. This system consists of tiny surgical instruments mounted on three separate robotic arms. A fourth arm contains a video camera that creates magnified, high-definition, three-dimensional images on a computer monitor to guide the surgeon during the procedure.

The surgical tools and camera are inserted through small incisions in the abdomen. The surgeon controls these instruments and the camera from a console in the operating room.

Robotic-assisted surgery enables doctors to access and clearly see difficult-to-reach locations of the body, such as the pelvis.

Doctors may use a transanal excision to remove small, early cancers in the lower portion of the rectum. With this operation, surgeons place surgical tools through the anus and into the rectum, using them to remove the tumor and some surrounding healthy tissue. This can help to ensure that all of the cancer has been removed.

Regional anesthesia is often provided for this procedure, rather than general anesthesia. The hospital stay may be as short as one day.

For early cancers located higher in the rectum, surgeons may use transanal minimally invasive surgery. During this procedure, a special device is used to inflate the rectum with air. Surgical instruments, including a small video camera, are inserted through this device. This allows the surgeon to see and remove the tumor. This technology also allows surgeons to remove cancers that would otherwise require an abdominal incision.

General anesthesia is used for this procedure. The hospital stay may be as short as one day.

For cancers in the rectum, surgeons may perform a low anterior resection. During this procedure, they remove part of the rectum along with a portion of the colon, then reattach the healthy colon to the remaining rectum or anus in the lower pelvis. Doctors also remove surrounding lymph nodes.

As with other types of surgery for colorectal cancer, a low anterior resection is typically performed using minimally invasively robotic or laparoscopic techniques, which reduce recovery time and blood loss. Sometimes, however, open surgery may be needed, which may require a hospital stay of up to one week.

To remove more advanced tumors in the lower part of the rectum involving the anal muscles, which control the ability to defecate, surgeons may perform an abdominoperineal resection. For this procedure, they remove the rectum, anus, and surrounding lymph nodes. They also perform a colostomy.

The doctors and nurses at NYU Langone’s Rusk Rehabilitation can help you learn how to care for the stoma, an opening in the abdomen attached to a colostomy bag, and adapt to emptying and changing the bag.

Abdominoperineal resection requires general anesthesia. Perlmutter Cancer Center surgeons can usually use laparoscopic or robotic approaches for the procedure, which help to reduce the amount of time spent in the hospital and speed recovery.