Dignity Health offers the most advanced procedures in colorectal cancer surgery. Our team of oncology experts are sensitive to your urgent needs and have compassion and humankindness. Our specialists work side-by-side to carefully review complex cases and develop personalized treatment plans.

Our skilled surgeons use minimally invasive surgical procedures to reduce risk and optimize outcomes. We invest in advanced imaging technologies and radiation therapies to target tumors with greater precision.

You should choose Dignity Health because we’ve built a reputation for innovative therapies and surgical techniques that minimize the need for temporary or permanent colostomies. Our holistic approach is evident in services designed to treat the whole person—mind, body, and spirit.

Colorectal cancer—cancer of the colon or rectum—is the third most common type of cancer and the second cause of cancer-related deaths in the U.S. Most cases of colon cancer begin as small groupings of noncancerous cells called polyps, which can become colon cancers over time.

Many people with colon cancer show no symptoms in the early stages of the disease. When symptoms appear, they will likely vary, based on the size and location of cancer cells. The symptoms are often attributed to other benign conditions.

Diagnosis

If your tests or symptoms are relevant to colon cancer, your doctor may recommend a colonoscopy. This procedure involves using a long flexible tube with a tiny video camera at the end to examine the colon and rectum. The tube can also be fitted with surgical tools for collecting tissue samples. If cancer is discovered, and it is small, your doctor may be able to remove it completely during the colonoscopy.

Treatment

Your treatment will largely depend on how advanced the cancer is and how far it has spread. Surgery may be the only required treatment, or it may be part of a broader treatment program. In many cases, surgery can be performed using minimally invasive techniques that require only small incisions. This includes laparoscopic or robotic technology. Our specialists at Dignity Health can help you understand the benefits and details of these techniques during your consultation.

Pre-surgery

Before your surgery, you may be asked to drink plenty of water and follow a special diet to help limit your discomfort. In some cases, your doctor may prescribe antibiotics to suppress the bacteria found naturally in your colon and prevent infection. The day before your procedure, we will recommend a clear-liquid diet and an enema or laxative to clean out your system.

If your cancer is at an early stage and confined to the rectum, your doctor may perform what is known as a local excision. It removes the cancer cells and some tissue from the rectal wall. It may be done through the anus or through a small cut in the rectum. It does not require a major abdominal surgery.

Procedures

For cancers of the colon, you may undergo a colectomy—a procedure that removes the cancer cells and part or all of the colon. When possible, a colectomy is done with laparoscopic or robotic surgery, which involves several small incisions in your abdomen. Your surgeon will pass a tiny video camera through one incision and special surgical tools through the other incisions.

The benefit of laparoscopic and robotic surgery is that smaller incisions generally mean:

• earlier return of bowel function
• faster recovery
• decreased blood loss
• reduced post-operative pain
• shorter hospital stay

The type of operation you undergo is largely dependent on your individual factors. Those who have had extensive abdominal procedures before, or those who have large tumors, may not be candidates for minimally invasive surgery. Your operation may also begin as a laparoscopic or robotic colectomy, but progress to an open procedure if deemed necessary by your surgeon.

Benefits of Robotic Surgery

With robotic surgery, colorectal surgeons benefit from improved 3D visualization and maneuverability within difficult-to-access pelvic spaces. Robotic surgery offers surgeons a high degree of precision, control, and dexterity.

In addition, the enhanced magnification helps surgeons minimize trauma to important nerves and vessels, thereby preserving important biological functions such as urination and sex, which are essential for quality of life.

Reconnection

Once the colon has been repaired or removed, your surgeon will reconnect your digestive system to allow your body to expel waste. There are different ways to do this.

Your surgeon may be able to stitch up the remaining portions of the colon so that stool is eliminated from your body as it was before the surgery.

If the colon and rectum are both removed, your surgeon may use a portion of your small intestine to create a pouch that is attached to your anus. This allows you to expel waste normally, though you may have several watery bowel movements a day.

Your surgeon may attach your colon or small intestine to an opening created in your abdomen called a stoma. If the colon is attached to the stoma, it is called a colostomy. If the small intestine is attached to the stoma, it is called an ileostomy. However, this situation is usually not permanent. Once you have recovered, another operation (known as a colostomy reversal or ileostomy reversal) can be done to put the ends of the colon back together or to attach the intestine to the colon. Sometimes the colostomy or ileostomy may need to be permanent.

An average hospital stay is two to four days for laparoscopic or robotic procedures and about three to five days for open procedures. You will be discharged when you:

• can tolerate a diet without needing IV fluids
• have evidence of bowel function
• have pain that is reasonably controlled

As your system recovers, you will transition from drinking clear liquids to soft foods, and eventually to solid foods.

Ostomies

If your surgery involved a colostomy or ileostomy, you will meet with a nurse who will show you how to care for your stoma and manage the appropriate appliance. Your nurse will also show you how to care for the incision site. Generally speaking, you will wash your hands first and avoid any creams, salves, ointments, or powders. You may take a shower, but don’t take a tub bath until your doctor approves it.

Recovery at Home

Once you leave the hospital, expect at least a couple of weeks for recovery. You may have a low appetite and feel weak at first, but eventually, your strength will return. Talk to your doctor about when you can expect to return to your normal routine.

Digestion

After colon surgery, most people have a bowel movement within two to five days. However, every person is different. Some people may use the toilet once every three days, while others may use it multiple times a day. It can take four to six weeks or more for your bowel habits to settle down to a regular pattern.

You may have some associated discomfort, particularly if bowel movements are hard. It is therefore important to keep your stools soft by drinking plenty of liquids and taking a stool softener as needed.

Medication

After surgery, you will receive medications in the hospital and will be discharged with a similar regimen. Non-narcotic pain medications are designed to be taken on a regular schedule every six to eight hours. They prevent the buildup of pain over time. You may be prescribed a narcotic medication for breakthrough pain; however, these drugs can cause constipation and are not for long-term use.

Be sure to read all warning labels or consult with a pharmacist regarding any potential drug interactions, and take medication only as directed by your physician.

Activity

When returning to work and other daily activities, do only what you are comfortable with. It is better to ramp up slowly than to get back to the same level of activity too fast.

After minor surgery, most people take at least two to five days off. After more extensive procedures, you may need up to a month of rest before you can sit comfortably for extended periods of time. You should avoid heavy lifting for at least a month after abdominal surgery, regardless of type.

Recovering from colorectal surgery can be both physically and emotionally taxing. Family and friends can make your recovery easier by providing compassionate care and exercising patience and understanding.

Dining and Travel — Dining out may not be possible in the weeks and months after surgery as your body will be adapting to bowel changes and dietary limitations. Travel may also be difficult as you may need to use a restroom more frequently.

Ostomies — Some conditions necessitate a colostomy or ileostomy, in which the upper end of the bowel or intestine is brought outside the abdomen and connected to a collection bag. Your caregiver can help ease the transition by providing both practical and emotional support. A good ostomy nurse can educate you and your caregiver on how to properly care for the appliance.