Colorectal Cancer

Surgical Procedures

Polypectomy

If the cancer is small, localized in a polyp and in a very early stage, the provider may be able to remove it completely during a colonoscopy.

During colonoscopy, the provider uses tiny tools passed through the scope to remove polyps or suspicious tissue. One removal option involves the use of a wire loop, called a snare, to isolate the polyp. The loop is then tightened and electrical current is applied to sever the polyp at its base.

This is called a polypectomy. If the cancer in the polyp does not involve the base, which is where the polyp is attached to the colon wall, then there is a good chance that the cancer has been completely eliminated during the polypectomy.

Some larger polyps may be removed using laparoscopic surgery. In this procedure, the surgeon performs the operation through several small incisions in the abdominal wall, inserting instruments with attached cameras that display the colon on a video monitor. The provider may also take tissue samples from lymph nodes in the area where the cancer is located, and test those samples for any sign of cancer.
 

Colectomy

Surgery to remove all or part of the large bowel is called colectomy or resection. In some cases, the provider may perform a partial colectomy, which involves removing the diseased portion of the colon. A hemicolectomy involves the removal of half of the colon. A proctocolectomy is the name for the procedure to remove the colon, anus, and rectum. During the surgery, lymph nodes near the colon are often removed and examined under a microscope.

In some cases, the provider will perform an anastomosis, where the healthy parts of the colon are joined together after the diseased portion has been removed. In other cases, the results of colon surgery will require an alternate path for waste to leave the body. The surgery to create the new opening in the abdomen for waste elimination is called ostomy, and the opening itself is called a stoma.
 

Laparoscopic-Assisted Colectomy

Laparoscopic-assisted colectomy is a procedure where part of the colon and nearby lymph nodes are removed. Unlike conventional colectomy, where one long incision is made in the abdomen, several smaller incisions are made during a laparoscopic-assisted colectomy. Surgical instruments are then inserted through these incisions to remove part of the colon and lymph nodes. One of the instruments has a small video camera on the end, which allows the surgeon to see inside the abdomen.

This procedure requires the same type of preparation before surgery and the same type of anesthesia during surgery as a conventional colectomy. However, because of the smaller incisions, there is usually less pain, and it usually takes less time to recover than after a conventional colectomy.
 

Colostomy

During a colostomy, the provider creates a small opening in the abdomen called an ostomy. Waste will travel through the small intestine and exit the body through the stoma, which is the end of the intestine that protrudes through the abdominal wall.

The stoma is about the size of a quarter and is usually located in the lower right part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed. Bowel movements may be more frequent and watery than before the procedure.
 

Ileostomy

This procedure is similar to colostomy, although it involves the small intestine, rather than the colon. During an ileostomy, the provider creates a small opening in the abdomen called an ostomy, and attaches the end of the small intestine, called the ileum, to it, creating a stoma.

Waste will travel through the small intestine and exit the body through the stoma. The stoma is about the size of a quarter and is usually located in the lower right part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed. Bowel movements may be more frequent and watery than before the procedure, with a total daily volume of about one liter.
 

Ileoanal Anastomosis

This procedure, also called a pull-through operation, allows the patient to have normal bowel movements because it preserves part of the anus. In this operation, the provider removes the colon and the inside of the rectum, leaving the outer muscles of the rectum. The provider then attaches the end of the small intestine, called the ileum, to the inside of the rectum and the anus, creating a pouch. This pouch is connected to the anal canal. Waste is stored in the pouch and passes through the anus in the usual manner. Bowel movements may be more frequent and watery than before the procedure.