Surgical Procedures & Innovations Colectomy

The vast majority of people who develop colon cancer will require surgical resection (removal) of a segment of the colon or rectum. Surgery to remove a portion of the colon, also known as "colon resection" or "colectomy," is a technically challenging operation in comparison to common laparoscopically performed procedures such as gall bladder removal and surgery to correct GERD (gastro-esophageal reflux disorder). In performing a colectomy, it is commonly necessary for the surgeon to operate in more than one area of the abdomen in order to separate the bowel from its blood vessels, resect the colon and join the two ends of bowel together (anastomosis).

Colon cancer surgery with anastomosis; first panel shows area of colon with cancer, middle panel shows cancer and nearby tissue removed, last panel shows cut ends of colon joined.

After the colon segment has been removed, it is necessary to enlarge one of the port wounds to an overall length of 5 to 7 cm. in order to safely withdraw the specimen from the abdomen and to facilitate the connecting of the open ends of the remaining bowel. Because of the need for this larger wound a more proper name for minimally invasive colectomy is laparoscopic-assisted colectomy. However, for brevity's sake, the term "laparoscopic colectomy" is often used. For purposes of comparison, the length of an open laparotomy incision for colectomy ranges from 15 to 28 cm.

Rarely, if the cancer is confined within a polyp that can be completely removed through the colonoscope, no other therapy may be necessary. However, follow up colonoscopies at 1 to 3 year intervals would be advised. When a colon resection is required, between 8 to 12 inches of colon are usually removed; the goal is to remove the entire segment of colon that contains the cancer. The segment's adjoining mesentery, which contains the blood vessels and lymph nodes that supply it, is also removed. This is because colon cancers can involve the lymph nodes and invade the blood vessels directly. Because the colon is on average four feet long and because tumors can develop anywhere along its length, the segment to be resected will vary from patient to patient. After the segment is removed, the two remaining ends of the bowel are joined together to reconnect the intestine. This reconnection is called an anastomosis.

The only tumor location that prohibits anastomosis is the very distal rectum, within a finger's reach of the anus. Those few with tumors in this location have a number of treatment options available; these are discussed in the section on rectal cancer. Some patients may unfortunately require a complete rectal resection, also called an abdominoperineal resection, and a permanent colostomy.

Your surgeon performs a colostomy to create a small opening, or stoma, in the abdominal wall through which feces exits the body. Depending on the size of the rectal tumor it may be possible to avoid this radical operation and treat the tumor in a way which does not require colostomy. But, if a stoma is necessary, specially trained nurses, in addition to your physician, will assist in its initial care. Today, this is simpler than in the past. The stoma nurse is a professional trained in the care and teaching of patients requiring colostomy. He or she is available for questions before or after your surgery at Columbia Presbyterian, and is an invaluable source of information, medical care and support.