Colon cancer is a type of cancer of the large intestine (colon) or the lower part of the digestive system. It usually begins as a small, non-cancerous (benign) clump of cells that are referred to as adenomatous polyps. Over time, certain polyps can become colon cancers. There are different types of surgery for colon cancer. Choosing the best type of surgery depends on the stage and placement (location) of the tumour. In this article, we will be taking a look at the different types of surgery for colon cancer including the possible complications of each one.
1. Partial Colectomy
A partial colectomy is often referred to as bowel restriction. It involves the removal of a part of the colon or rectum with cancer. Lymph nodes nearby are also taken out and tested for cancer. Then, the healthy parts of the colon or rectum are sewn back together. It can be done by opening the abdomen or by laparoscopy. The procedure requires general anesthesia and recovery after surgery may take 4 to 7 days in the hospital. In cases where two parts of the colon or rectum cannot be reattached, a colostomy is performed. The possible problems after surgery include scar tissue, leak between two joined sections of the colon or injury to the bladder/ureter/blood vessels.
2. Abdominoperineal Resection
The main indication for abdominoperineal resection is rectal carcinoma located on the lower one-third of the rectum. It involves the removal of the anus, rectum and a portion of the sigmoid colon along with nearby lymph nodes. An incision is made in the abdomen and perineum then a colostomy is done. The possible complications are similar to the aforementioned colon cancer surgeries. Recovery also takes a few weeks.
3. Laparoscopic Surgery
Laparoscopic surgery is recommended as an alternative to open surgery for certain cases of colon cancer. This includes if it is suitable for the particular case of the patient or if the surgeon has been trained thoroughly in laparoscopic surgery for colon cancer. This type of surgery is less invasive and there is a lower risk of complication. The decision on whether to use open or laparoscopic surgery should only be made after extensive discussion of the patient and surgeon especially taking into consideration the risks and benefits of the two procedures.
A colon polypectomy involves the removal of polyps on the inner lining of the colon. A polyp is a mass of tissue that can become cancer after some time. Complications from this procedure are rare but possible including damage to parts of the colon wall, infection and bleeding. The polyp will then be sent to a laboratory for testing. Complete recovery is usually around two weeks.
5. Right Colectomy or Ileocolectomy
A laparoscopic ileocolectomy is an operation that can be used for colon cancer which involves the removal of a diseased section of the ileum (last part of the small intestine) and ascending colon. In a right colectomy, the ascending colon is removed but the ileum is left untouched. Recovery usually takes 1 to 3 weeks after surgery and the patient may need to be confined for a few days. The patient will have to be on a soft diet for a few weeks after surgery. The possible complications include wound infection, urinary infection, anastomotic leak and prolonged ileus.
Colectomy is a surgical procedure that involves the removal of the entire or a portion of the colon depending on the location of the cancer and if it has spread. It usually requires another procedure for reattaching the remaining parts of the digestive system for the elimination of digestive waste from the body. Generally, the complications can include bleeding, deep vein thrombosis, pulmonary embolism, infection and injury to nearby organs.
7. Endoscopic Mucosal Resection
Gastrointestinal endoscopic mucosal resection is a procedure that removes cancerous or abnormal tissues from the digestive tract. It is performed using a long, narrow tube that is equipped with a light, video camera and other instruments. It can be passed down the throat for problems in the esophagus, stomach or upper part of the small intestine. However, for colon cancer, it is guided up through the anus. The risks of the procedure include bleeding, perforation and narrowing of the esophagus. Recovery after surgery can take several days to a few weeks.
A proctosigmoidectomy is an operation that removes diseased sections of the rectum and/or sigmoid colon. After the diseased section of the colon is removed, the ends of the remaining colon are re-joined. The surgery is completed using a laparoscope so only a very small incision of about 5 to 10 mm is made on the abdomen. After surgery, recovery period is a few weeks depending on the extent of the surgery. The possible complications are bleeding, perforation and damage to other organs.
9. Local Excision
This type of surgery is for cancer that is found at a very early stage. The surgeon can even remove the cancer without cutting the abdominal wall by putting a tube with a cutting tool through the rectum into the colon to cut the cancer out. This procedure reduces perioperative complications and preserves anorectal, bladder and sexual function. However, the procedure is not recommended for cancers with worrisome features like lymphovascular invasion. Recovery is usually around one to two weeks after surgery.
Resection is a term for any operation that removes tissue or part of any organ in the body. In bowel resection, the tumor and part of the colon or rectum is removed. It takes out the part of the colon where the cancer is located and nearby lymph nodes are taken out and tested. Recovery in the hospital can take 4 days up to 2 weeks depending on the extent of the surgery. There are many possible complications after surgery including a leak in two joined sections of the colon, injury to organs and scar tissue.
11. Total Proctocolectomy
A total proctocolectomy is performed under general anesthesia. The surgery involves the removal of the colon rectum and anus. After the surgery, an ileostomy is performed to enable the body to eliminate waste. An ileostomy involves pulling part of the small intestine through an opening in the lower abdomen and attaching it to the stomach. Waste is then eliminated by the small intestine into a disposable bag worn over the surgical opening. Like with major surgeries, there are several risks and heavy bleeding, damage to nearby organs or infection is possible. Other complications include scar tissue that blocks the intestines, reduced nutrient absorption and irritation/infection around the surgical opening.
12. Stomas or Ostomies
A stoma is an opening of a part of the intestine (small or large) onto the skin. A colostomy is an opening of the large intestine or colon onto the skin while an ileostomy is an opening of the small intestine or ileum onto the skin. An ileostomy or a colostomy can be permanent or temporary depending on the case of the patient. It is permanent when the stool is not able to go through the normal route after a surgery. Temporary stomas are for keeping stool away from the damaged area to allow healing. The stool that comes out is collected in a disposable bag.
13. Fecal Diversion
This procedure is for creating an ileostomy (an opening between the skin’s surface and small intestine) or colostomy (an opening between the skin’s surface and the colon). This is usually just a temporary measure used in order to allow the healing of an infection, chronic inflammation or recent surgery. The most common complication is infection but there are also others like skin irritation, hernia, narrowing of the bowel and prolapse of the bowel.
14. K Pouch
The K pouch or continent ileostomy is a fancy form of the ileostomy but it doesn’t need to be attached to a bag outside of the body. The K pouch provides a reservoir for stool and has a nipple valve that prevents the leakage of stool. It is emptied by using a stiff catheter which is inserted through the stoma. The stoma is covered using gauze when it is not being emptied. A common problem with the pouch which is also the reason surgeons don’t recommend it is that the valves can come undone or slip requiring another surgery for repair. The surgery is complicated and there are many long-term problems.
15. Ileal (J) Pouch
As previously mentioned, this is for replacing the rectum and providing a place for the storage of stool before going to the bathroom after having a total proctocolectomy. A pouch is created by the surgeon on the end of the small intestine (ileum). There are different forms of the ileal pouch but the most common is the “J” pouch because it is easier to make. Creating the pouch is a complex procedure and can sometimes not work properly. To improve the success rate, the surgeon will make a temporary ileostomy in order to allow the pouch to heal before having to defend itself from stool. The temporary ileostomy is typically reversed after 2 to 3 months.