What Is a Colectomy? What to Know About Colon Cancer Surgery

What Is a Colectomy?

A colectomy is surgery to remove all or part of a colon that contains a tumor or is diseased or damaged.

Colon and rectal cancer are conditions for which this is a treatment option, and it may also involve removing nearby lymph nodes.

Colon cancer can begin as polyps in the large intestine or inside the rectum. Colonoscopy and similar screening methods can lead to early detection of these polyps, and early detection can lead to a complete recovery.

However, if cancer cells grow and spread through a person's body, they have "metastasized ", which creates a more serious situation.

Colon Cancer Statistics

2020 Turkey Cancer Statistics report that 12217 people were diagnosed with colon cancer and 8741 with rectal cancer. These cancers caused 6545 and 4178 deaths, respectively, and colorectal cancers accounted for 8.5% of cancer-related deaths in Turkey.

In 2021, colon cancer accounted for 8.7% of cancer-related deaths in the United States.

This article covers what to expect before, during, and after a colectomy. It also covers risks, complications, and more.

Below is an outline of the anatomy of the colon and rectum to help explain colectomy.

What Are the Types of Colectomy?

Colectomy is the preferred form of treatment for early-stage colon and rectal cancers.

There are several types of colectomy, including the following (discussed in more detail below):

• partial or subtotal colectomy
• total colectomy
• hemicolectomy
• total proctocolectomy

What Is a Stoma?

In some cases, to allow stool and other waste to leave the body, the surgeon will need to bring a section of bowel to the skin through a permanent or temporary stoma (mouth, opening).

A colostomy bag is attached to the stoma to collect stool.

Why Is Colectomy Surgery Performed?

General surgeons performing this operation may recommend a colectomy for the following medical conditions:

• Ulcerative colitis
• Colon cancer
• Chron disease

Before colectomy surgery, they will usually perform a colonoscopy. This involves using a light and camera on a thin tube to examine the colon.

Preparing for Colectomy Surgery

Before any surgical procedure, all patients undergo some tests, the benefits and possible risks of surgery are explained, and informed consent is obtained.

Tests

Before surgery, the patient will undergo various tests and examinations, which may include:

• Blood tests
• Chest X-rays, computed tomography (CT), ultrasound, MRI, or PET-CT as examples of radiological imaging
• Urine tests

A surgeon will need to know the person's entire medical history, including current illnesses or serious past illnesses. It is also important to know the patient's current symptoms and the medications they take, especially blood thinners such as aspirin.

A healthcare professional may advise people who smoke to try quitting smoking before surgery to reduce the risk of a lung infection after the operation.

Medications

The surgeon will explain which pain medications to use after the procedure and how to care for the incision. Recommendations will include how to reduce or change any medications that could affect healing, the response to anesthesia, or blood clotting.

What Happens on the Day of Colectomy Surgery?

In general, the doctor advises the patient to avoid eating for at least 6 hours before surgery.

It is also advisable to leave valuables such as jewelry at home.

On the day of surgery, a person will need to bring certain items to the hospital or medical center. These may include:

• a list of all prescription medications, over-the-counter medications, herbal medicines, and other supplements they take
• insurance information and identification
• comfortable, loose-fitting clothes
• shoes that do not require bending down to put on

The discussion with the anesthetist on the day of surgery should cover:

• any allergies the person has
• preexisting health conditions
• any dentures / dental plates they have
• any details about their alcohol or drug use

What Happens During a Colectomy?

Colectomies are performed under general anesthesia. The operation is carried out either as open surgery or with laparoscopic assistance, which is more commonly preferred today.

Laparoscopic Colectomy

During a laparoscopic colectomy, a surgeon inserts small flexible ports or tubes through incisions in the abdomen. Lights and other surgical instruments are inserted through thin tubes placed in these small openings made by the incisions.

They can then remove the diseased or damaged part of the colon and stitch the two ends together or create a stoma.

Open Surgery

In an open colectomy, a surgeon accesses the colon through an incision in the abdomen and removes the part containing a tumor or disease. They may also remove some of the surrounding healthy tissue.

They then stitch the ends together, known as an anastomosis, or create a stoma.

If open colectomy surgery is for cancer treatment, the surgeon may also remove some lymph nodes near the colon for microscopic examination to check for cancer.

Types of Colectomy – Illustrated Explanation

The method chosen for colectomy surgery depends on the size of the area containing the tumor / damage and therefore on how much of the colon needs to be removed.

The surgeon selects one of the following methods:

• Sigmoidectomy: This refers to removing the sigmoid colon, the curved part of the descending colon that connects to the rectum.
• Right hemicolectomy: This refers to removing the right or ascending colon.
• Left hemicolectomy: This refers to removing the left or descending colon.
• Segmental resection: This refers to removing short segments of the colon.
• Total colectomy: This refers to removing the entire colon. A surgeon then connects the small intestine to the rectum.
• Low anterior resections (LAR): This means removing the upper rectum.
• Transverse colectomy: This means removing the midgut or transverse colon.
• Abdominal perineal resection: This means removing the rectum, anus, and sigmoid colon and adding a permanent colostomy.
• Total proctocolectomy: This means removing all or part of the colon and rectum.

When Are a Stoma and Colostomy Bag Necessary?

A stoma may be necessary if the surgeon cannot stitch the two separate ends of the bowel together. In a procedure known in Turkish as opening a colostomy, a bag is attached to an opening on the outside of the body to collect stool (a colostomy bag).

The colostomy may be temporary, and the surgeon may close it after the lower colon has healed, usually within 2-3 months. During the second operation, they reconnect the colon inside the body. However, the stoma may also be permanent.

What Are the Risks of a Colectomy?

Patients should discuss the potential benefits, risks, and complications of a colectomy with their general surgeon.

Risks and complications commonly associated with colectomy include:

• leakage of colon contents into the abdomen
• infections
• pneumonia and other lung problems
• blood clots in blood vessels or the lungs
• postoperative bleeding
• a gastrointestinal fistula (a perforation in the intestines) or an unusual connection between two body parts
• organ or tissue adhesions
• stroke or heart attack
• death

After a Colectomy

Patients should ask their doctor when to seek medical advice or care after surgery.

In general, they should seek immediate medical attention if they experience any of the following symptoms:

• persistent nausea
• vomiting
• leakage or discharge from the wound
• severe pain
• abdominal cramps
• fever
• a bad smell or discharge from the incision
• increasing swelling or redness around or over the incision
• blood in the stool
• a swollen abdomen
• no bowel movement for 2-3 days / prolonged constipation

How Long Does It Take to Recover from Colectomy Surgery?

Most people stay in hospital for 3-4 days after laparoscopic-assisted or open colectomies unless there are complications.

People experiencing vomiting, nausea, or an inability to urinate may need to stay in hospital longer.

After having their first bowel movement following surgery, a person can usually return to normal eating within 3-4 days.

Many people return to normal activities 1-2 weeks after laparoscopic-assisted surgery and 2-3 weeks after open surgery.

People should avoid strenuous activities, exercise, and heavy lifting 4-6 weeks after colectomy surgery.

Treatment After Colectomy

After surgery, a medical oncologist may recommend treatment to reduce the risk of cancer recurrence, using adjuvant therapies (for example, FOLFOX chemotherapy).

A person's condition after colectomy surgery depends on several factors, including:

• the severity or extent of colon disease or damage
• how much of the colon and surrounding tissue the surgeon removed
• any complications occurring during or after surgery
• the person's general health
• the person's age

A study involving people who had undergone colectomy for ulcerative colitis found that 84% of patients reported improved quality of life after the procedure.

In the same study, 81% of patients experienced symptoms such as reduced body image, depression, anxiety, sexual dysfunction, and reduced work productivity after colectomy.

Summary

A colectomy is a type of surgery to remove all or part of a colon that contains a tumor or is diseased or damaged.

Most people spend a few days in hospital after colectomy surgery but can return to most nonstrenuous activities within 1-4 weeks.

Some people may need to use a permanent or temporary colostomy bag.

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