Colorectal cancer is generally a malignant tumor disease of the colon (colon carcinoma) and rectum (rectal carcinoma). The following text provides an overview of the colon cancer surgery procedures available to surgeons and the consequences that patients can expect after colon cancer surgery.
Cancer of the small intestine and anus(anal cancer) is rare. Colorectal cancer is a malignant tumor disease of the large intestine ( colon carcinoma) and rectum (rectal carcinoma). These types of cancer are also known as colorectal carcinomas.
Colorectal cancer can develop in all sections of the colon and rectum. However, it most frequently occurs in the lower 30-40 centimeters. Benign, often fungus-like tumors, known as intestinal polyps, are often precursors to colorectal cancer.
The most important treatment for bowel cancer is bowel cancer surgery. This involves removing the affected section of the colon and the area of the lymphatic and blood vessels supplying it.
If the cancer is very advanced and there is no prospect of a cure, doctors usually do not perform bowel cancer surgery. Unless they need to prevent complications such as a bowel obstruction.
Bowel cancer surgery is not considered an emergency operation (except in the case of bowel obstruction), so there is sufficient time for diagnostics and treatment planning. This helps to avoid complications and improve the chances of recovery.
In most cases, surgery is performed immediately after a diagnosis of colon cancer @ Emil /AdobeStock
Colon cancer operations are performed in many clinics and in specialized colon centers. Colorectal centers are clinics that are particularly suitable for the care of patients with colorectal cancer.
The primary aim of colorectal cancer surgery is to completely remove the tumor and thus cure the cancer.
In addition to the removal of the bowel tumor, bowel cancer surgery also includes
The diagnosis of the lymph nodes is important for staging. Staging is the classification of cancer into stages. Doctors can use this to plan treatment and assess the prognosis.
Furthermore, bowel cancer surgery may be necessary if there is a risk of bowel obstruction (obstructed intestinal passage) due to adhesions.
A curative bowel cancer operation is when doctors are able to remove all of the tumor tissue (including metastases in lymph nodes and organs).
During bowel cancer surgery, doctors not only remove the directly affected section of bowel, but also the surrounding healthy tissue. This is intended to reduce the risk of a new tumor (recurrence). As individual cancer cells may have settled in the regional lymph nodes, doctors also remove these.
In palliative bowel cancer surgery, on the other hand, doctors try to reduce tumor-related complications and symptoms. It is used for patients with more advanced bowel cancer (e.g. metastases). In these cases, there is no longer any prospect of a cure.
If the tumor grows into the bowel, it can obstruct the passage of bowel contents. This can lead to a life-threatening intestinal obstruction.
The bowel surgeon attempts to shrink the tumor so that the narrow passage is free again.
Palliative bowel cancer operations also include
Before a bowel cancer operation, doctors must clarify the condition and location of the tumor in the bowel and its extent. This is done using extensive diagnostic procedures.
The most common examinations include
Colonoscopy is the most important medical examination for the early detection of colorectal cancer @ Graphicroyalty /AdobeStockBefore and during colon cancer surgery,the bowel is thoroughly cleansed with a special solution that has a laxative effect. The patient takes this by mouth. The patient is also given an antibiotic against infections.
This is because bacteria in the intestinal flora can cause dangerous infections in the abdominal cavity. It is also necessary to shave the area where the incision is made. Thrombosis prophylaxis is also important .
Colon surgeons basically distinguish between two techniques for colon cancer surgery.
Depending on the extent and severity of the tumor, colorectal cancer surgery can be performed openly using laparotomy (open abdominal surgery) or minimally invasively.
In the case of small tumors that are not located in the deeper layers of the bowel, doctors can remove the tumor during a colonoscopy.
If there is any doubt as to whether tumor tissue is still present, doctors will perform a normal bowel cancer operation.
A "normal" bowel cancer operation can be performed as follows:
A laparotomy is used for colorectal cancer at a later (advanced) stage due to the extent of the cancer.
Otherwise, laparoscopic tumor removal is now an established procedure for patients with colorectal cancer. Although it is widely used, it should still be performed by an experienced surgeon.
It provides a similarly good result to open colorectal cancer surgery. A significant advantage is that the procedure is gentler and patients recover more quickly.
Cancer cells in colorectal cancer tend to break away from the primary tumor and settle elsewhere in the body. There they form metastases (also in the lymph nodes). Doctors remove these with a large safety margin during radical bowel cancer surgery.
The surrounding healthy tissue and the associated lymph nodes, lymph vessels and blood vessels are also affected by the removal.
Radical surgery is crucial for successful tumor removal and to prevent recurrence. However, it is often only during the operation that doctors can identify what needs to be removed.
To prevent tumor cells from spreading during the operation, doctors tie off blood and lymph vessels that are connected to the tumor. They also separate the tumor-bearing section of bowel from the healthy bowel.
Without touching the tumor (no-touch technique), they detach the section with lymph and blood vessels and lymph nodes.
The no-touch technique is intended to prevent the tumor from falling apart and the tumor cells from spreading.
If the tumor is so large that neighbouring organs are affected, experienced surgeons perform radical en bloc surgery. They then remove not only the large tumor, but also the affected organs in one piece (en bloc). Here, too, they avoid injuring or touching the tumor.
In local colorectal cancer surgery, doctors only remove the tumor itself with a safety margin. It can only be performed on small tumors at an early stage, whereby the following procedures are generally used:
Doctors do not perform radical colon cancer surgery if:
An artificial bowel outlet (stoma or anus praeter) is a connection between the healthy bowel and the abdominal wall. This allows the bowel contents to pass to the outside. This connection can be permanent or only temporary.
Doctors rarely need to create a permanent stoma for colon cancer. In difficult cases, a temporary stoma may be necessary to relieve the bowel or bowel suture after colon cancer surgery.
In the past, doctors had to remove the rectal section and the sphincter muscle for rectal cancer. This was done for tumors that were located near the anus. Today, the sphincter muscle remains intact in most cases.
Experienced rectal surgeons are able to maintain a safety distance of 1 cm from the anus to prevent a stoma.
Doctors create a temporary artificial anus during bowel cancer surgery in order to relieve the bowel with the fresh suture.
The stoma directs the bowel contents to the outside, allowing the bowel and the bowel suture to heal in peace. This stoma is also called a relief stoma.
A temporary bowel outlet is usually a double-run stoma. Doctors pull the bowel (small or large intestine) out through the abdominal wall. They cut it open from above and turn it outwards so that two intestinal openings are visible.
After 2-3 months, they restore the natural digestive tract and put back the artificial anus. They close the opening in the abdominal wall.
Around 70 percent of all stoma carriers have cancer @ Zane /AdobeStock
If the tumor is located close to the sphincter muscle, the anus cannot be preserved. Doctors then have to remove the rectum and the sphincter muscle. A permanent, terminal stoma is used for this bowel cancer operation.
With a terminal stoma, doctors guide the lowest, healthy part of the colon outwards through an opening in the abdominal wall. There they stitch it to the skin.
After a period of familiarization and appropriate instruction, most patients cope well with a permanent stoma. Even regular bowel evacuation is possible.
Special plasters or stoma caps are available for water sports (e.g. swimming pools) and saunas. There are also practically no restrictions for stoma wearers with regard to their occupation or choice of sport.
Like any other operation, bowel cancer surgery also involves risks and dangers. Serious complications of bowel cancer surgery can include bleeding in the abdomen, wound healing disorders and infections.
Other risks and complications after bowel surgery include
Anastomotic insufficiency: An anastomosis is the connection between two anatomical structures. Intestinal ends that are sutured together or the suture between the intestine and skin at the artificial anus can leak or tear. Intestinal contents can enter the abdominal cavity and cause peritonitis (inflammation of the peritoneum).
Digestive problems: As food absorption is already largely complete in the large intestine, large intestine operations are less problematic for food utilization than small intestine operations. However, reabsorption of water takes place in the large intestine. The thickening of the stool can therefore be impaired. This results in more or less severe diarrhea. Many patients, especially ostomy patients, complain of digestive complaints such as flatulence, constipation and odors. Patients then change their diet, which can lead to an unbalanced diet.
Fecal incontinence, bladder dysfunction, sexual dysfunction (potency problems in men): Operations on the rectum can irritate and damage nerves in the operating area. With modern bowel cancer surgery procedures, however, the risk is low.
Adhesions: In most cases, adhesions are harmless and painless, but occasionally painful and dangerous due to restricted bowel motility and passage obstruction.
Only regular follow-up care can detect metastases (secondary tumors) or recurrences (recurrence of a tumor at the original site) at an early stage.
After successful bowel cancer surgery, the following follow-up examinations are available, among others:
For nutritional reasons, patients who have undergone bowel cancer surgery hardly need to change their eating and drinking habits. However, due to digestive complaints (flatulence, diarrhea, constipation, odors), you should pay attention to regulating your stool.
To avoid an unbalanced diet, you should heed the following nutritional tips:
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