Surgery is commonly the recommended treatment for many incidences of bowel (or 'colon cancer' / 'colorectal cancer'). It involves the removal of the section or sections of bowel affected by the tumour/s. In some cases, surgery is one component of the overall treatment, in conjunction with other treatments, for example chemotherapy or radiotherapy.
Where the cancer affects the rectum, it has been found that chemotherapy and radiotherapy before surgery improve the outcome, however other types of cancer affecting the bowel, for example carcinoma (colon cancer) do not respond as well to other treatments.
How should I prepare for surgery?
The day before admission we will contact you to confirm admission time and to give you instructions regarding any fasting requirements for the procedure. You should bring any x-rays in with you (and ensure you take them with you when you are discharged). Also bring any current medication in with you to the hospital.
For day procedures you should not drive yourself home when you are discharged - please ensure you have made other transport arrangements.
If you smoke, you should reduce smoking before your procedure. Our strong recommendation is that you give up entirely at least 6 weeks before the procedure, or at least one week beforehand. Smoking greatly increases the possibility of chest infection and hampers natural wound healing.
In the case of major surgery, please inform Dr White's team if you take:
- Anti-inflammatory medication.
We will need to discuss these medications with you prior to your surgery.
Dr White will provide you with a full set of pre-operative instructions for your specific surgery well ahead of the day of surgery.
What is involved in the procedure?
There are two common surgical techniques used in treating bowel cancer - conventional ('open') surgery and laparoscopic ('keyhole' / 'minimally invasive') surgery. Open surgery involves making one relatively large incision to the abdomen to allow the surgeon to operate directly on the internal organs.
Laparoscopic surgery on the other hand, involves a number of much smaller incisions to the abdomen, through which special surgical instruments are introduced to the body cavity, as well as a miniaturised video camera which allows the surgeon to visualise the internal organs and operate on them. The most suitable approach for each individual case will depend on a number of factors, which Dr White discusses with all patients prior to surgery.
During surgery, once the affected section of the bowel has been removed, the remaining two sections are joined together. This procedure is called 'anastomosis'. In some cases, it is not possible to perform anastomosis, in which case a colostomy will need to be fitted, either on a permanent or temporary basis.
Most patients generally need to stay in hospital for up to a week after bowel cancer surgery. Older patients, or those who live alone may need to stay in hospital a little longer.
After bowel cancer surgery, in many cases patients are advised to adopt a different approach to food intake for the 8-10 week period after surgery. If this is the case, you are advised to:
- Cut down on the intake of fibre in the diet.
- Eat smaller portions.
- Chew all food well before swallowing.
In addition, you may also be advised of further dietary requirements, and in most cases, patients are advised not to take laxatives during this period, unless you have been advised by Dr White that you can.
Dressings to any incisions must stay on for five days after surgery – after this they can be removed. If staples have been used to close the incision/s, they are removed 7-10 days after surgery.
If a colostomy has been fitted
Nurses specialised in using and advising on how to use a colostomy (a type of 'stoma') are available to help patients who have been fitted with a colostomy after bowel cancer surgery. Once you return home, community stoma therapists can visit you at home to continue to assist you.
It is important to remain relatively active after returning home after surgery - this helps with recovery. Strenuous exercise (e.g. weight training, working out at the gym, strenuous sports, work involving heavy labour or operating heavy machinery) should be avoided during the first 4-5 weeks after surgery.
During this period walking regularly and normal activity around the home should make up the bulk of exercise. These guidelines apply where the surgery was minimally invasive – if the procedure was conducted as open surgery, these recovery times will be longer, and Dr White will be able to advise of these recovery guidelines if they are different.
You can start driving again 3 weeks after minimally invasive surgery, and 5 weeks after open surgery.
All types of surgery are subject to the following risks, which are rare, but can occur:
- Allergic reaction to medication / anaesthetic.
- Difficulty breathing.
Specific to this type of surgery the following risks are also rare, but can occur:
This is where the sections of the colon that have been reconnected do not heal properly or develop an infection at the connection point. More surgery or the fitting of a colostomy may be required.
Bowel / bladder issues
These may be caused by an obstruction or blockage in the colon, or damage may have occurred to ureters (tubes that connect the kidneys and the bladder) during surgery
Injury or perforation may occur to nearby organs, such as the bladder, kidneys and spleen.
Sexual function (in males)
After this type of surgery in rare cases sexual function may be inhibited ie an inability to ejaculate or have an erection
When to contact Dr White
If you experience any of the following you should contact Dr White immediately (or your doctor / GP or out of hours go to your local emergency department):
- Difficulty urinating.
- High temperature / fever.
- Pain that is severe or getting worse.