Removing the cancer by surgery is a common first step for patients with colorectal cancers. Because rectal surgery can result in urinary or sexual dysfunction, it is important that a skilled and experienced surgeon, who provides nerve-sparing surgery, performs the the procedure. Our surgeons are specialists in the treatment approaches to colorectal cancer and perform the following state-of-the-art procedures:
- Colectomy: Surgery that removes the portion of the colon containing the cancer. How much of the colon is removed depends on blood supply, lymph node drainage patterns, tumor location and the extent of your disease. At Roswell Park, our surgeons perform:
- Laparoscopic colectomy or laparoscopic rectal resection
- Robot-assisted colectomy or robotic rectal resection
- Open colectomy or rectal resection
- Transanal endoscopic microsurgery: A minimally invasive surgery procedure performed through the anus for early stage rectal tumors and for tumors in patients who have multiple other health conditions.
- Endoscopic mucosal resection: A procedure performed through an endoscope to remove early tumors of the colon or rectum.
- Lymph node surgery: Removing the lymph nodes associated with the portion of the colon or rectum that is removed, is an important part of treatment and staging. Lymph nodes must be removed and analyzed properly to determine whether or not they contain cancer. A tumor that has spread to lymph nodes is an indication for other therapies such as chemotherapy.
- Mesorectum surgery: For patients with rectal cancer, surgery involves removing the rectum along with the surrounding envelope of lymphatic tissue, called the mesorectum. Ensuring complete surgical removal of this envelope by a skilled surgeon is paramount to a better outcome from rectal cancer.
Will I Need an Ostomy (Colostomy or Ileostomy) Bag?
Sometimes surgeons need to remove a section of the colon or rectum to effectively remove all the cancer, and will then reconnect the healthy parts. If reconnecting the colon isn’t possible, the surgeon creates a new path for wastes to leave the body through an opening (stoma) in the wall of the abdomen. Waste is collected in a flat pouch worn outside of the body. The operation to create a stoma from the colon is called a colostomy, whereas a stoma from the small intestine is called an ileostomy.
For most people, the stoma is temporary. Once the colon or rectum heals, the surgeon can reconnect them and close the stoma.
For some rectal cancer patients, especially those that undergo chemoradiation prior to surgery, a temporary loop ileostomy will be in place for several weeks to allow healing time and completion of other therapy. When the time is right, the ileostomy is removed with another small surgical procedure.
Whether or not a colostomy is permanent depends on how close the tumor is located to the muscles that control the bowel movements (sphincter muscles) and the tumor’s stage. For certain rectal cancers, having chemotherapy and radiation treatment before surgery may reduce the need for a permanent colostomy. Choosing a highly trained and experienced surgeon can help maximize your chance of avoiding a permanent colostomy.