Colorectal Cancer Treatment, Surgery

Colorectal Cancer Treatment

Surgery is the treatment of choice for colorectal cancer. Treatment depends on the stage of the disease and the overall health of the patient. Chemotherapy and radiation therapy may be used as adjuvant treatment (i.e., in addition to surgery).

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Colorectal Cancer Surgery

Radical bowel resection, also called partial colectomy and hemicolectomy, is used to treat 80-90% of colorectal cancer patients. This procedure may be performed through a large incision in the abdomen (called open surgery) or through several small incisions (called laparoscopic surgery).

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In this procedure, the tumor is located using a no-touch technique (i.e., the surgeon locates the tumor without manipulating the colon to avoid releasing cancer cells into the bloodstream). The segment of the colon that contains the tumor and the nearby lymph nodes are removed and healthy segments of the colon are reconnected, if possible (called end-to-end anastomosis). Removal of the lymph nodes is called lymphadenectomy.

If the colon cannot be reconnected, a temporary or permanent colostomy is performed. Approximately 15% of patients require a permanent colostomy.

Radical bowel resection is performed under general anesthesia. Several days before surgery, antibiotics are prescribed and the patient's diet is restricted to ensure that the entire colon is empty. These measures help reduce the risk for postoperative infection.

Recovery varies depending on the patient's age and overall health, and the extent of the surgery. After surgery, patients may experience pain, weakness, fatigue, and loss of appetite. Dietary modifications may be necessary until the digestive tract heals. Complications include the following:

• Allergic reaction to anesthesia
• Formation of a blockage of the intestine
• Formation of blood clots (e.g., pulmonary embolism)
• Infection
• Leakage at the reconnection site

Laparoscopic surgery (e.g., right or left hemicolectomy, partial colectomy) may result in a shorter hospital stay and a faster recovery time. Complications include injury to the colon or ureter (tube that carries urine from the kidney to the bladder), excess carbon dioxide in the blood (hypercapnia), and development of a hernia at the incision site.

Colorectal cancer that invades adjacent tissues or organs (e.g., stomach, liver, kidneys, small intestine, ovaries, abdominal wall) usually is treated by removal of the entire tumor, including part of the adjacent tissue or organ.

Surgical procedures used to treat metastatic colorectal cancer may include partial hepatectomy (removal of part of the liver) and oophorectomy (removal of the ovaries).

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