Surgery for rectal cancer

Treatment for rectal cancer often requires a multidisciplinary approach. Your treatment will consist of radiotherapy - sometimes in combination with chemotherapy - followed by an operation.

Nowadays, an increasing number of patients won't need a permanent colostomy. Most patients with tumors located further from the anus will now only need a temporary colostomy. Patients with tumors located very close to the anus may still need a permanent colostomy, however, although even these numbers are decreasing thanks to our newly developed technology, even when the tumor is positioned low in the rectum.

The amount of patients who need a permanent colostomy rapidly decreases. Most patients with tumors located further from the anus will now only need a temporary colostomy. Patients with tumors located close to the anus often still require a permanent colostomy, however, although recently developed technology allows us to avoid this in some cases, even when the tumor is positioned low in the rectum

Surgery for rectal cancer - what to expect?

The surgery aims to remove the tumor together with the affected lymph nodes. This can usually be accomplished through keyhole (laparoscopic) surgery.

Once the tumor is removed, your intestines will need be stitched back together. A temporary colostomy can help protect these seams. If the tumor developed towards the end of the rectum, we may be able to attach the intestine to the sphincter, in which case your colostomy will also be temporary. If your sphincter needs to be removed, however, you will need a permanent colostomy.

The complecity of the surgery you will have depends on the size and location of your tumor.

Effectiveness

The treatment’s success depends on the size of the tumor and the amount of lymph nodes that are affected. If the tumor is small and has not spread to the lymph nodes, the overall success rates are high. These rates decrease as the tumor grows in size and spreads to the lymph nodes.

Nevertheless, most rectal cancer operations are curative.

Preoperative screening

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

whether you have been under anesthesia before
whether you have any other conditions
whether you have taken cancer medicine before
whether you have had radiation treatment before
whether you have any allergies
whether you smoke
whether you drink alcohol
what kind of medication you take

Please inform your anesthesiologist of the type of medication and dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

General or local anesthesia

Before your surgery you will be given general anesthesia, local anesthesia, or a combination of the two. General anesthesia means that you will be completely unconscious during surgery, whereas local anesthesia means that a part of your body will be numb and motionless.

General anesthesia

General anesthesia completely sedates your body. You will be given a cocktail of sleeping medicine, pain killers, and sometimes a muscle relaxant through IV. You will be unconscious within 30 seconds. You will be ventilated during the entire process.

If you are having major surgery, we will place a respiration tube in your throat. For smaller surgeries, a small cap in the back of the throat will suffice. We will closely monitor your heart rate, blood pressure, breathing, and temperature through our monitoring devices.

Local anesthesia

If you are given local anesthesia, you will be conscious during your surgery. Local anesthetics are usually administered through an epidural in the spine, and will temporarily numb all body parts underneath. We may place a tube to give you IV pain medication during and after surgery.

Your anesthesiologist will keep a close eye on your blood pressure, heart rate, breathing, and temperature in order to adapt the anesthesia if needed.

Most people undergoing major surgery will be given a mixture of general and local anesthetics.

Side-effects and complications

The most common complication is an anastomotic leak at the intestinal seams. Your exact risk will depend on the location of the tumor and the radiation.

If you experience an anastomotic leak, you will have to come in for surgery again and will be given a colostomy. This colostomy will most likely be permanent. If your sphincter was removed during the surgery, there is a chance that you will experience impaired wound healing. It may take weeks or months to recover.

After your surgery

The average admission time for keyhole surgery is 5 days. If you need open surgery, you will have to stay at the hospital for a week up to 10 days. Patients who require a removal of the sphincter will have to stay for longer. Any further complications or an impairment in wound healing will further extend your stay.

You will have to come in for follow-up screeningsand regular screenings with your ostomy specialist, clinical nurse specialist, and surgeon. The frequency of these screenings will depend on your tumor type and stage.

Depending on the results of the pathological tests of the removed tissue, you may need to come in for further treatment.

Fertility preservation

This treatment may negatively affect your fertility levels, which is why the Netherlands Cancer Institute offers fertility preservation.