Surgery

The surgical removal of a tumour offers the best chance of a cure for patients who have early-stage cancer. The surgeon, with your multidisciplinary team, will determine if the cancer is only in your bowel, assess your general wellbeing and fitness for an operation, and discuss with you what the surgery involves. How you recover from bowel surgery will depend on many factors.

An operation on your bowel is a major procedure, and you may feel tired for weeks or even months afterwards. You may find that you need to take four to six weeks off work, and most surgeons recommend that you do not lift heavy objects. You may have altered bowel habits after surgery (for example, more frequent, looser motions). It can take up to a year for your bowel habits to settle into a routine because the bowel has been shortened. You may also find that your bowel produces more wind than before, and this can sometimes build up in the abdomen and cause pain. If you are struggling with this, talk to your doctor; they can suggest some ways of managing it. Some people find that their bowel is always more active than before their surgery.

However, there are two things you can do to help your recovery from surgery:

  • Increase your physical activity before your surgery if you can (for example, walk short distances).
  • Aim to stop smoking well before any surgery is performed, if you currently smoke.

When planning for your hospital stay, consider the following:

  • your transport—how you will get to hospital and home again
  • your support person—arrange to have someone at home with you for at least two or three days after you leave hospital. They can help with tasks such as shopping, laundry and housework
  • your medical certificates—request medical certificates from your doctor if needed

There are several things the surgeon and anaesthetist need to know about you before your surgery. A few days before surgery you will be asked:

  • if you have had problems with a general anaesthetic before or if you have any allergies
  • if you have diabetes. If you have diabetes, make sure you tell your doctor. Your blood sugar levels will need to be checked during your stay in hospital
  • what medications you are taking (names, doses and times of day that they are taken).

You will be told what day and time you need to stop eating or drinking before surgery.

The type of operation you have will depend on:

  • where the cancer is in your bowel
  • the type and size of your cancer
  • whether your cancer has spread.

How long you stay in hospital will depend on the type of operation you have.

Surgery to remove part of the bowel is called a colectomy. If the left side of the bowel is removed, it is called a left hemicolectomy.

Left hemicolectomy

lh

Diagram showing the part of the bowel removed with a left hemicolectomy
(Copyright Cancer Research UK)

If the middle part of the bowel is removed (the transverse colon), it is called a transverse colectomy.

Transverse colectomy

tc

Diagram showing the part of the bowel removed with a transverse colectomy
(Copyright Cancer Research UK)

If the right side of the bowel is removed, it is called a right hemicolectomy.

Right hemicolectomy

rh

Diagram showing the part of the bowel removed with a right hemicolectomy
(Copyright Cancer Research UK)

If the sigmoid colon is removed, it is called a sigmoid colectomy.

Sigmoid colectomy

J pouch

For cancers in the lower part of the rectum, the surgeon removes the rectum. If possible they join the end of the colon to the anus. This join is called a colo-anal anastomosis. Sometimes the surgeon uses the end of the colon to make a pouch, called a J pouch. This acts like the rectum to store bowel movements before you go to the toilet. In such situations you may need to have a stoma while your bowel heals. In most cases the stoma can be reversed after a few months.

(Source: Bowel Cancer UK)

If your tumour is in the middle part of your back passage, your surgeon may remove most of the rectum and attach the colon to the anus. Sometimes the surgeon makes a small pouch by folding back a short section of colon or by enlarging a section of colon. This small pouch then works like the rectum did before surgery.

Anterior resection/high anterior resection

ar

Diagram showing the part of the bowel removed with a sigmoid colectomy
(Copyright Cancer Research UK)

After your surgeon removes the part of the bowel containing the tumour and the surrounding lymph nodes, the ends of the colon are joined back together. The place where they join is called an anastomosis. Sometimes, to give the area time to heal, the surgeon makes a temporary colostomy or ileostomy higher up the bowel (see below for explanations of colostomy and ileostomy). You may have the stoma reversed in another operation several months later to rejoin the bowel. This is called a stoma reversal. In the meantime you will have a stoma bag over the opening of the bowel.

If you have a large amount of colon removed (total colectomy), your surgeon may not be able to join the ends of the bowel that are left. You may need to have a permanent ileostomy or stoma.

Colostomy

If, for some reason, the bowel cannot be rejoined, the upper end can be brought out onto the skin of the abdominal wall. This is called a colostomy and the opening of the bowel is known as a stoma. A bag is worn over the stoma to collect bowel motions. The operation to rejoin the bowel is known as stoma reversal. If it is not possible to reverse the colostomy, the stoma is permanent. 

Ileostomy

Some people need to have an operation in which the end of the small bowel (ileum), or a loop of ileum, is brought out to the right side of the abdominal wall, called an ileostomy. As with a colostomy, bowel motions are then collected in a bag worn over the stoma.

(Sources: Cancer Research UK and Macmillan Cancer Support UK)

A stomal therapist will see you before and after surgery to teach you to manage your stoma. There are many stoma products available and the therapist will work with you to find the one that suits your individual needs.

Ostomy bags and appliances are supplied free if you are a New Zealand citizen. You may find it helpful to get in touch with someone else who has had a stoma and talk to them about how they manage theirs. Your stomal therapist, local Ostomy Society or Cancer Society will be able to help. Visit the Ostomy Society website (www.ostomy.org.nz) or call the Cancer Information Helpline 0800 CANCER (226 237)

Surgery for rectal cancer

You may have radiation treatment or chemotherapy, or both, to shrink a tumour before surgery to make it easier to remove.

If the cancer is in the upper part of your rectum, your surgeon removes the part of the rectum containing the tumour. This is called a low anterior resection.

Low anterior resection

 lar2lar

(Copyright Cancer Research UK)

If the cancer is in the lower part of your rectum, your surgeon cannot leave enough of the rectum behind for it to work properly, so they remove your anus and rectum completely. This is called an abdominoperineal resection (AP resection). Then the surgeon diverts the remaining bowel to make an opening on your abdomen. This is called a colostomy. 

Abdoperineal resection

abr

Diagram showing an abdominal resection of the bowel

(Copyright Cancer Research UK)

For people who have an AP resection, their colostomy will be permanent.

Keyhole bowel surgery (laparoscopic resection)

For small bowel cancer the surgeon can use keyhole surgery (laparoscopic resection). The surgeon makes several small cuts in your abdomen instead of making one large cut. The surgeon passes a long tube called a laparoscope and other instruments through these cuts. They look through the laparoscope to do the operation. The surgeon then removes the tumour through a small cut. This type of surgery can take longer than a traditional open operation. However, the stay in hospital may be shorter.

If the cancer blocks the bowel

Usually, your surgery for bowel cancer will be planned in advance, after your tests have found the cancer. But sometimes the cancer completely blocks the bowel; this is called a bowel obstruction. In this situation you need an operation straight away. The surgeon may put a tube called a stent into the bowel. The stent keeps the bowel open so that it can work normally again. You may have immediate surgery to remove the cancer from the bowel, or a stoma may be formed to relieve the obstruction. 

Side effects of surgery

An operation on your bowel is a major procedure, and you may feel tired for weeks or even months afterwards. You may find that you need to take four to six weeks off work, and most surgeons recommend that you do not lift heavy objects. You may have altered bowel habits after surgery (for example, more frequent, looser motions). It can take up to a year for your bowel habits to settle into a routine because the bowel has been shortened. You may also find that your bowel produces more wind than before, and this can sometimes build up in the abdomen and cause pain. If you are struggling with this, talk to your doctor; they can suggest some ways of managing it. Some people find that their bowel is always more active than before their surgery.

(Source: Macmillan Cancer Support UK)

Talk to your doctors and nurses about what you can expect. You may find it helpful to talk to a dietitian about what to eat. There are medications available to help manage changes in your bowel habits.

For advice on suitable foods to eat and other tips, read the Cancer Society’s booklet Bowel Cancer and Bowel Function. You might find the sections on diarrhoea, a low-fibre diet and a low-residue diet useful. 

For some people, bowel surgery affects their sexual function. See our booklet Sex and Cancer for information.

After surgery

You will be encouraged to start moving around as soon as possible. Even if you have to stay in bed, it is important to move around to help your circulation and prevent blood clots. You may be given special support stockings to wear before and after your operation.