Surgical Management of Colorectal Cancer

The diagnosis of colorectal cancer has increased drastically both among older and younger individuals. In fact, it remains the third most common type of cancer worldwide, with new cases and deaths happening every year.

However, with timely screening and treatment, it is possible to increase the five-year survival rates of patients. Colorectal cancer surgery remains one of the effective ways to remove the malignant cells from the colon and rectum. However, advancements in treatment methods have also reshaped the way surgeons approach cancer care.

In this blog, we will discuss surgical intervention for colorectal cancer, its types, when it is recommended, and what the recovery process looks like.

Understanding Colorectal Cancer

Colorectal cancer refers to a group of malignant cells that originates in the colon and rectum (parts of the large intestine). It typically begins as benign polyps on the inner lining of the colon or rectum, which, left untreated, turn cancerous over time.

When caught in the early stages, colorectal cancer is treatable, often with excellent treatment outcomes. Initial evaluation during the first stages allows for less invasive procedures and even increases the long-term survival chance. However, as the disease progresses, treatment becomes difficult and involves a combination of procedures such as chemotherapy, radiation therapy, and targeted therapy, along with surgery.

Hence, surgeons suggest regular screening and medical attention to make a difference in survival chances.

When is Surgery Recommended for Colorectal Cancer?

Dr. Purnendu Bhowmik, one of the best colorectal cancer surgeons, recommends surgical intervention in the following cases.

• Localised stages: Surgery is performed when the cancer is localised, i.e., it is between Stage I and III.
• Metastatic cancer: It is also considered for patients who are in Stage IV, especially with metastases. It involves removing these metastases along with the primary tumour.
• Large polyps: If the biopsy confirms the presence of polyps, surgery becomes necessary.
• Obstruction or bleeding: Emergency surgery is required in situations when the patients suffer from bowel obstruction or severe rectal bleeding.

The decision to proceed with surgery and its duration depend upon the stage of the cancer, the structure of the tumour, and the patient’s risk.

Types of Colorectal Cancer Surgery

The primary goal of colorectal cancer surgery is to remove the original tumour and, in some cases, any advanced metastatic lesions that have spread to other parts of the body. If required, surgical intervention is also suggested to remove the distant cancer cells in the liver, lungs, and peritoneum.

Depending on where the malignant cells are located in the colon, different sections of it are removed, which include the following.

Right Hemicolectomy: It involves excision of the ascending (right) colon.

Left Hemicolectomy: Here, the surgeon cuts off the descending (left) colon.

Sigmoid Resection: It includes the removal of the sigmoid colon.

Extended Hemicolectomy (Right or Left): Resection includes part of the transverse colon.

In all the above procedures, the corresponding part of the intestines is removed along with the regional lymph nodes and any part of the nearby organs affected by the tumour.

Surgical Method for Rectal Cancer

Total mesorectal excision (TME): The standard procedure for killing cancer cells in the rectum is total mesorectal excision. It includes the removal of the entire rectum along with the mesorectum (fatty tissue that contains blood vessels and the lymph nodes that surround the rectum). It is an effective procedure for reducing the risk of recurrence and long-term outcomes.

What are the Surgical Techniques For Colorectal Cancer?

Colorectal cancer surgery is usually performed using the following surgical techniques.

• Laparotomy (Open surgery): It is a conventional method where the surgeon makes a large incision in the abdomen to remove the affected colon or the rectum. Surgeons usually perform the procedure in cases where the tumours are large and hard to reach.
• Laparoscopy (Minimally invasive surgery): It is a modern, less invasive technique where the surgeon makes 3 to 4 holes in the abdomen from where instruments are inserted to operate.

Laparoscopic procedures have become the preferred method due to their noninvasive nature and faster recovery time. However, the choice of method depends upon the tumour’s size and location.

Prognosis of Colorectal Cancer Surgery

The prognosis for colorectal cancer surgery depends on factors such as the stage of the disease, characteristics of the tumour, and its removal with a clear margin. When caught early, surgical intervention for colorectal cancer provides excellent outcomes. For stage 1, the survival rate can be as high as 90% with localised tumours. However, the rate significantly decreases with advanced-stage diagnosis, with nearly 14% for distant metastasis cancers.

In Stage III and Stage IV colorectal cancers, adjuvant therapy is often required in the form of chemotherapy, radiation therapy, or targeted therapy to shrink the tumours, prevent recurrence, and improve outcomes.

Recovery Process After Colorectal Cancer

The recovery after colorectal cancer surgery varies depending on the type of procedure. However, in most cases, it involves a few days of hospital stay to monitor any signs of infections, bleeding, or blood clots.

During the first few weeks of recovery, patients are kept on a liquid diet and then gradually transitioned into solid foods. It is normal to experience changes in bowel movements, like constipation or more frequent stools. This is temporary and persists for some days.

For patients for whom a colostomy is created, surgeons receive guidance on how to care for the stoma.

Conclusion

Colorectal cancer surgery is the most effective treatment for patients diagnosed with colon or rectal cancer. As medical technology is advancing, the future of surgical interventions will offer better outcomes with an increased survival rate and a more personalised approach for patients.

If you are suffering from colorectal cancer, make sure to consult a reputable colorectal surgeon like Dr. Purnendu Bhowmik, who can enhance your chance of recovery and help you lead a healthy life.