Surgery for Colorectal Cancer

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Surgery is usually the first treatment for colon cancer and for some rectal cancers.


Colon Cancer

Surgery helps to remove as much of the cancer as possible. In early stages, the cancer may be removed during a colonoscopy. The removal is called a polypectomy or a local excision.

If this is not possible, a colon resection may be recommended. The surgeon will remove all or part of the colon. This can occur one of 2 ways. In open surgery, the surgeon makes a long cut in the abdomen. They will remove the tumor through this opening. In laparoscopic surgery, small cuts are made in the abdomen. A surgeon will use a camera and small tools to perform the surgery. Laparoscopic surgery usually has a shorter recovery time than open surgery.


Rectal Cancer

The goal of surgery is to remove as much of the cancer as possible. During surgery, the doctor will try to save the anal sphincter. The anal sphincter is the muscle that controls bowel movements.

Several procedures are used to treat rectal cancer. Like colon cancer, some cancers can be removed during a colonoscopy. The removal is called a polypectomy or a local excision. When that is not possible, other forms of surgery may be needed. The type of surgery will depend on the stage and location of the cancer.

A small cancer that is contained within the inner layers of the rectum may be removed through the anus. This can occur using one of these procedures:

  • Transanal excision: This is used for early-stage cancers found in the lower rectum.
  • Transanal endoscopic microsurgery (TEMS): TEMS is used for cancers that are higher in the rectum.
  • Transanal minimally invasive surgery (TAMIS): TAMIS is a faster procedure with a shorter recovery.

Total mesorectal excision (TME) is a laparoscopic procedure. It is used when the tumor is larger. During a TME, a surgeon will remove the rectum. They will also remove nearby fat, blood vessels, and lymph nodes. Transanal total mesorectal excision (TaTME) is a new form of TME. It is used when cancer is found in the lower part of the rectum. In this case, the cancer can be reached through the anus. Most patients will receive chemotherapy and radiation therapy prior to TME.

If the cancer has spread widely, a more major surgery may be needed. A surgeon may remove organs such as the bladder, ovaries, cervix, or vagina. If possible, your doctor will try to spare the anal sphincter. These procedures include a low anterior resection and an abdominoperineal resection. A low anterior resection may require a temporary ostomy. An abdominoperineal resection requires a permanent ostomy.

Your doctor may recommend chemotherapy and radiation before surgery. This will help shrink the size of the tumor. It also helps reduce the need to remove the anal sphincter. In some cases, chemoradiation is offered before surgery. Chemoradiation is the combined use of chemotherapy and radiation therapy. It is given if the cancer has spread to or beyond outer layers of the rectal wall or to the lymph nodes.

Surgery for rectal cancer takes special skill because the cancer is harder to reach. Be sure to choose a board-certified colorectal surgeon who is experienced with rectal cancer.



An ostomy is a surgical procedure. It changes the way waste, like urine or stool, can exit the body. For most people with colorectal cancer, an ostomy is used to help stool exit the body. An ostomy may be needed when all or part of the colon or rectum is removed.

During the ostomy surgery, an opening in the skin is created over the abdomen (belly). This opening is called a stoma. An external pouch is typically worn over the stoma to collect any waste.

Some ostomies are temporary and only needed for a short period of time. This may be due to the side effects of a cancer treatment or a medical complication. Once healed from surgery, temporary ostomies can be reversed. A permanent ostomy is needed when any organs can no longer function or are removed.

Types of ostomies include:

  • Colostomy: This surgery occurs when a part of the colon or rectum is removed. An opening is created in the abdominal wall so that waste can exit the body. Colostomies may be temporary or permanent.
  • Urostomy: A urostomy is typically permanent and cannot be reversed. When the bladder can no longer function, your doctor may recommend a urostomy. This surgery redirects urine so that it can pass from the kidneys to a pouch outside of the body. The most common urostomies are the Ileal or Cecal conduit procedures. During an ileal conduit surgery, a section of the small intestine (ileum) is removed. During a cecal conduit surgery, a section at the beginning of the large intestine (cecum) is removed.
  • Ileostomy: This surgery may be temporary or permanent. An opening is created from the lowest part of the small intestine. The intestine is redirected to the abdominal wall. During an ileostomy, all or part of the colon may need to be removed.


Ostomy & Colorectal Cancer

An ostomy can help you live longer and improve your overall quality of life. Learn about different kinds of ostomy procedures, the effects on your body, and coping methods.


Surgery Side Effects

After surgery, a person may develop bands of scar-like tissue. These bands may form inside the abdomen. They are called abdominal adhesions. Adhesions are very common, and many people will never know they have them. Sometimes adhesions can cause serious problems. This includes intestinal obstruction or blockage.

Symptoms may take months or years after surgery to occur. When they do, the most common ones are gas pains and stomach cramps. Other symptoms include bloating, nausea, constipation, and vomiting. You may also experience abdominal pain during exercise or stretching. If these adhesions cause complications, your doctor can treat them with surgery.

Contact your healthcare team right away if any of these symptoms last more than a day:

  • Waves of stomach cramps that get worse right after eating
  • Excessive pain in your abdomen
  • An unexplained fever

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