Bowel Cancer Surgery

When surgery is possible

The extent of surgery is determined by the segment of bowel in which the tumor lies and by how far it has spread.

• Localized tumor without complications — elective resection of the corresponding segment of bowel together with the mesentery and lymph nodes. This is the most common scenario.
• The tumor invades neighboring organs or the abdominal wall — the procedure is extended, and the affected structures are removed as a single block.
• Complicated tumor — obstruction, perforation, bleeding: first the threat to life is dealt with; sometimes radical resection can be performed right away, sometimes as a second stage.
• There are liver metastases — surgery remains possible if all lesions can be removed completely, enough healthy liver will remain, there is no uncontrolled spread beyond the liver and the patient’s condition allows the procedure. The sequence of procedures is determined by a tumor board.

If the metastases cannot be removed yet, treatment starts with chemotherapy, and the question of surgery is reconsidered after a follow-up examination. A conclusion of “inoperable” made six months ago does not describe today’s situation.

Hemicolectomy and other operations on the large bowel

The operations are named after the segments of bowel, because “its” vessels and lymph nodes are removed together with the tumor.

Operations for rectal tumors have their own specifics — see the page “Rectal Cancer Surgery”. The diagnosis itself, symptoms and tests are covered on the pages “Colon cancer” and “Colorectal cancer”.

Hemicolectomy: what to know

A hemicolectomy is removal of the right or left half of the colon together with the vessels, mesentery and lymph nodes that drain the affected segment. This extent is determined not by the size of the tumor but by lymphatic drainage: the tumor spreads through lymph nodes along the vessels, so the whole lymphatic basin is removed together with the bowel. The removed lymph nodes are examined, and their status determines whether chemotherapy is needed after surgery.

• right hemicolectomy — for tumors of the cecum and ascending colon; the last part of the small bowel is removed together with the large bowel, so for the first weeks stools are more frequent and looser: both water absorption and bile acid metabolism change;
• left hemicolectomy — for tumors of the splenic flexure and descending colon;
• extended hemicolectomy — when the tumor lies on the border between the territories of two vessels, for example in the transverse colon.

When the tumor location allows it, hemicolectomy is performed laparoscopically — through a few small incisions. The ends of the bowel are usually joined right away.

Sigmoid colon surgery

The sigmoid colon is the S-shaped loop between the descending colon and the rectum. Its lumen is narrower than in the right-sided segments, so a tumor narrows it early: some patients learn of the diagnosis only when bowel obstruction develops.

In planned surgery the sigmoid colon is removed together with the mesentery and lymph nodes, and the ends of the bowel are usually joined right away — a stoma is rarely needed. The risk that the join will not heal is higher in emergency surgery, in malnourished patients and with poor blood supply to the bowel ends; in such cases the surgeon may deliberately choose a temporary stoma.

In acute obstruction, the options are emergency resection or relieving the bowel with a stoma or, in selected cases without perforation, a stent placed through a colonoscope. After decompression, the planned resection of full extent is performed once the patient’s condition has stabilized. The diagnosis itself is covered on the page “Sigmoid colon cancer”.

How the operation is performed

The extent of resection is determined by the location of the tumor, its vascular and lymphatic territory and local spread: together with the segment of bowel, the mesentery with the lymph nodes draining this particular segment is removed. After that the ends of the bowel are usually joined right away.

When the location and size of the tumor and previous operations allow, the procedure is performed laparoscopically — through several small punctures. In colon surgery this approach is used often. Large tumors, invasion of neighboring organs and emergency situations increase the likelihood of open surgery. The approach is chosen before the procedure based on the CT findings and your condition. The duration of the operation depends on its extent and the approach.

Is a stoma needed

In elective colon surgery — rarely: the ends of the bowel are usually joined right away. A stoma is created mainly in emergency operations for obstruction or perforation, and when the condition of the tissues does not give confidence that the join will heal. In such cases it is most often temporary.

Hospital stay, recovery and consequences

After surgery, care follows the enhanced recovery (ERAS) protocol: early mobilization, early return to eating, controlled pain relief. The length of the hospital stay depends on the extent of surgery and the approach — after a laparoscopic procedure it is usually shorter.

After a right hemicolectomy, bowel movements are more frequent and looser for the first weeks: the large bowel has become shorter. This is expected and gradually settles; eating small frequent meals and drinking enough fluids help.

Whether chemotherapy is needed after surgery is decided based on the final histology report: the stage, the status of the lymph nodes and other features of the tumor.

Risks and complications

Risks are what patients ask about least often, although they are the most important thing to discuss before surgery. The main ones are:

• anastomotic leak — when the join in the bowel does not heal; it can lead to abdominal infection, a repeat operation and creation of a stoma;
• bleeding and wound infection;
• impaired bowel passage — a temporary slowing of bowel function after surgery, or mechanical obstruction, which requires urgent treatment;
• thrombosis — which is why early mobilization after surgery is important.

Sharp pain, fever or inability to pass gas after discharge is a reason to see a doctor immediately. I will explain the risks in your particular case at the consultation: they depend on the segment of bowel, other conditions and whether the operation is elective or emergency.

What the cost depends on

The cost of surgery depends on its extent, the approach, the number of days in the hospital and the tests before surgery. The exact amount is named once the treatment plan has been defined. The payment can be split into parts — installments are available. The in-person consultation is free. More details are on the page “Cost of Surgery: What It Depends On”.

Which documents are needed and how to book

• CT discs and, if available, MRI — the discs with the images, not only the reports;
• the colonoscopy report describing the segment in which the tumor is located;
• the histology report and, if available, the blocks and slides and the MMR/MSI test result;
• records of previous operations and chemotherapy regimens with the number of courses;
• recent blood tests, including a complete blood count, iron studies and CEA.

Book a consultation by phone or through the form. If you are from another city, send the documents in advance — how to do this is described on the page “Online Oncologist Consultation”.