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Your Guide to Colorectal Cancer Surgery Types Preparation Recovery and Outlook

Medically reviewed by Julie Scott, DNP, ANP-BC, AOCNP — By Kristeen Cherney on September 16, 2022Colorectal cancer is a type of cancer that forms in either your colon or rectum. The National Cancer Institute estimates there will be 151,030 new cases of colorectal cancer in 2022, as well as 52,580 related deaths. Colon cancers start in your colon, the longest part of your large intestine. Rectal cancers start in your rectum, further down your large intestine. Colon and rectal cancers are often grouped under the umbrella term “colorectal cancer” because of similar traits and treatments. Surgery is the most common treatment for colorectal cancer. Doctors consider its use at all stages. This article will review the types of colorectal cancer surgeries available. We’ll cover how doctors perform the different types of surgeries, what recovery looks like, and other important information to discuss with a doctor.

Types of surgeries for colorectal cancer

There are several types of surgery for colorectal cancer. The type a doctor recommends to you will depend on:where the cancer startedthe stage of the cancer (how much it has spread)your overall health Below are the possible options you may discuss with a doctor.

Local excision

If colorectal cancer is still in an early stage, a doctor may recommend removing it with a local excision. They may also use a local excision for cancerous polyps in the colon or rectum (polypectomy). Unlike more invasive surgeries, this procedure does not involve making any incisions. A doctor will perform a local excision during a colonoscopy. While looking through a scope, they’ll remove tumors along the lining of your rectum or colon.

Partial colectomy with anastomosis

In cases when colorectal cancer involves larger tumors, a doctor may instead recommend removing the cancer along with a portion of healthy tissues surrounding it. This process is known as a partial colectomy. After a partial colectomy, a surgeon may sew back together the parts of your colon not affected by cancer. This is called anastomosis. Along with a partial colectomy with anastomosis, a doctor may recommend removing nearby lymph nodes to check them for cancer, too. In most cases, at least 12 lymph nodes are removed.

Partial colectomy with colostomy

If you need a partial colectomy but a doctor can’t sew your colon back together, they may perform a colostomy instead. This process creates a small opening on the outside of your body called a stoma. The purpose of the stoma is to provide an opening for the colon to pass waste through. A surgeon will attach a removal colostomy bag to collect the waste.

Total colectomy

Rarely, you may need to remove your entire colon. Doctors most often recommend a total colectomy when they discover hundreds of polyps.

Low anterior resection

For stage 1, 2, and 3 rectal cancers, a doctor may recommend a low anterior resection (LAR). Similar in principle to a partial colectomy, LAR involves removing the part of the rectum affected by cancer. The surgeon will then connect the remaining part of the rectum to your colon.

Abdominoperineal resection

Also used to treat stage 1, 2, and 3 rectal cancers, a doctor may recommend abdominoperineal resection if they find that the cancer is growing near the sphincter or levator muscles. These muscles help prevent stool leakage and control urine flow, respectively. In this procedure, a surgeon removes the rectum, anus, and sphincter muscles. You’ll need a permanent colostomy after this procedure.

Diverting colostomy

If your cancer has spread to other areas, it may block the rectum and prevent stool from passing through. In this case, you’ll need a diverting colostomy. A diverting colostomy doesn’t remove the cancer, but it relieves the blockage. This allows you to recover so you can start other treatments, such as chemotherapy. Doctors make an incision in the colon above the cancer. They’ll then create a stoma to allow stool to pass through. You’ll also need a colostomy bag to collect the waste.

How is colorectal cancer surgery performed

Medical teams can use a variety of methods to perform colorectal cancer surgery. They include:

Open surgery

Open surgery is perhaps the most invasive surgical option. The surgeon will make a large incision in your abdomen to remove the tumor. Because of the incisions, recovery from this type of surgery may take some time. Open surgeries have become a less popular option in recent years. A 2017 study with more than 1 million people with colorectal cancer found a 35.4% decrease in the number of open surgeries. Despite the growing popularity of other surgical options, open surgeries remain the most common.

Laparoscopic surgery

Also called “keyhole” surgery, this method involves several small incisions in your abdomen. The surgeon will thread a camera (called a laparoscope) and other instruments through to locate and remove the cancer. This is a less invasive option since there’s no large incision, but a surgeon still makes cuts to your abdomen. Laparoscopic surgery may have additional benefits. According to a 2017 study, it tends to be significantly cheaper than open surgery. It also usually has a quicker recovery process.

Robot-assisted laparoscopic surgery

As the name suggests, this process is the same as traditional laparoscopic surgery, except a surgeon operates a four-armed robotic system to perform the work. Robot-assisted surgery offers more precision. As such, it may carry a lower risk of complications during and after the procedure. Despite being the most costly option, a 2017 study found that robot-assisted surgery did not provide substantially better outcomes than regular laparoscopic surgery.

Which option is best

You and your doctor can discuss which procedure may be best for your situation. You may also want to consider other factors, such as cost and recovery time. In general, recovery from open surgery takes longer. A 2020 study found that hospital stays after laparoscopic surgery were 17% shorter on average. According to a 2022 review, the cost of colorectal cancer surgery varies greatly, ranging between $1,149 and $30,606. A small 2018 study found that robot-assisted surgery was 53% more expensive than regular laparoscopic surgery. Keep in mind that surgery costs don’t include other associated fees, such as hospital stays. Costs will also vary depending on insurance. Surgery typeInvasivenessRecoveryCostopenmost invasivelongestmoderatelaparoscopicminimally invasiveshorterleast expensiverobot-assistedminimally invasiveshortermost expensive

How do I prepare for colorectal cancer surgery

Before colorectal cancer surgery, a doctor may recommend you follow a special diet. You may also need to take laxatives to clean out your colon. This is similar to a colonoscopy preparation. If you will be under general anesthesia, your doctor will ask you not to eat or drink anything after midnight the morning of your surgery. Your doctor may also ask that you stop taking certain medications or supplements before surgery, especially those that thin your blood. Do not stop taking prescribed medications on your own, though. Your doctor will advise you if and when you need to do so.

What can I expect during recovery from colorectal cancer surgery

It can take several weeks to fully recover from colorectal cancer surgery. The exact timeline depends on the extent of surgery, the cancer stage, and whether you have side effects. At first, you may experience pain from the surgery itself. A doctor may prescribe pain medications to help you feel better. You may not be able to eat solid foods for a few days after your surgery. You will need to temporarily follow a liquid diet instead. If you underwent surgery that required incisions, it’s possible to develop scar tissue in your abdomen. In severe cases, you might need future surgery to remove the scar tissue if it’s blocking your bowels. While rare, it’s possible to experience leakage from your colon following a colectomy. Contact your doctor right away if you’re suddenly experiencing:severe abdominal paina hardened bellyfeverlack of appetiteinability to pass stool After surgery, you may need other treatments, such as chemotherapy or radiation therapy.

Colostomy after surgery

You may need a colostomy after colorectal cancer surgery. How long you need one depends on the extent of the colectomy. You’ll have a temporary colostomy while your colon heals, usually for a few months. But it may be permanent when a surgeon removes the entire lower portion of the colon.

What is the outlook of colorectal cancer after surgery

Colorectal cancer has a 65% 5-year relative survival rate. Many factors can affect those chances, including the stage of your cancer and your overall health. A 2021 study found that surgery completely cured people with stage 1, 2, or 3 colorectal cancer 50% to 95% of the time. Success was less likely for people with very large tumors or cancer that had spread to the lymph nodes.

Alternatives to colorectal cancer surgery

Depending on the stage and type of cancer, surgery may not always be the best option. A doctor may also talk with you about alternatives to colorectal cancer surgery, including:Chemotherapy: This treatment kills cancer cells in your body. You may undergo chemotherapy with surgery or in cases of advanced colorectal cancer that has spread.Targeted therapies: In certain situations, targeted therapy may be an option. Doctors often use it after or with chemotherapy.Radiation therapy: You may undergo radiation before or after surgery, or with chemotherapy. It’s also more common in rectal cancer than colon cancer.Immunotherapy: These medications change your immune system to help it recognize cancer cells and destroy them. Immunotherapy may work best in advanced stages of colorectal cancer.Radiofrequency ablation (RFA): If you have colorectal cancer that has spread to other organs, such as the lungs or liver, doctors may use RFA to treat it. They’ll insert a thin probe through your skin into the tumor. The probe emits high energy radio waves that destroy cancer cells.Cryotherapy: Also called cryosurgery, this treatment also involves a thin probe, but it destroys cancer cells by freezing them. Like RFA, doctors use it to treat cancer that has spread to other organs. However, it can treat larger tumors than RFA.

Frequently asked questions

How long does surgery for colorectal cancer take

The duration of your surgery will depend on the type of surgery. While the surgery itself may take 1 to 3 hours, you will also be in the hospital for several more days in recovery.

Will I have to change my diet after colorectal cancer surgery

Immediately after colorectal cancer surgery, your doctor will place you on a liquid-only diet. After a few days, you may be able to eat solid foods. Talk with a doctor if you’re experiencing appetite loss following your surgery.

Can I have sex after colorectal cancer surgery

As a rule of thumb, avoid having sex after colorectal cancer surgery for at least 6 weeks, or when your doctor says it’s safe to do so. It’s also common to experience sexual dysfunction after having this surgery. Talk with a doctor if you’re experiencing pain, low libido, or other issues.

Takeaway

Surgery is the most common treatment for colorectal cancer. There are several types of colorectal cancer surgery. The type you have will depend on what type of cancer you have, the cancer stage, and your overall health. The type of surgery you have will also affect your recovery time and total cost. Talk with a doctor about all of your surgical options for colorectal cancer. They can help you make the most informed decision to eliminate your cancer and preserve your overall quality of life. Last medically reviewed on September 16, 2022

How we vetted this article

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cancerresearchuk.org/about-cancer/bowel-cancer/living-with/sex-lifeOur experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Sep 16, 2022 By Kristeen Cherney, PhD Edited By A. L. Heywood Medically Reviewed By Julie Scott, DNP, ANP-BC, AOCNP Copy Edited By Sara Giusti Share this articleMedically reviewed by Julie Scott, DNP, ANP-BC, AOCNP — By Kristeen Cherney on September 16, 2022

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