- Cancer Removal: Surgery physically removes cancerous tissue from the body, reducing the overall tumour burden and preventing further spread.
- Diagnostic Clarity: The surgical procedure allows for detailed examination of removed tissue and lymph nodes, providing precise staging information to guide additional treatment decisions.
- Symptom Relief: Surgery addresses immediate complications like obstruction or bleeding, improving patient comfort and quality of life.
- Survival Improvement: Complete surgical removal of localised cancer increases the chances of long-term survival and potential cure.
Colorectal Cancer Surgery
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Colorectal cancer surgery removes cancerous tissue from the colon or rectum through surgical intervention. The procedure may involve removing the affected segment of the bowel, nearby lymph nodes, and potentially surrounding tissues, followed by reconnecting the healthy portions of the intestine to restore normal bowel function.
Indications for Colorectal Cancer Surgery
Several specific conditions and diagnostic findings determine when colorectal cancer surgery becomes the recommended treatment option:
- Confirmed Presence of Tumours: A biopsy-proven diagnosis of cancer in the colon or rectum requires surgical intervention to remove the malignant tissue.
- Bowel Obstruction: Tumours blocking the passage of stool through the intestine need immediate surgical attention to prevent complications and restore proper bowel function.
- Bleeding Complications: Active bleeding from tumours that cannot be controlled through other methods may require surgical management.
- Stage-Specific Requirements: Early-stage cancers confined to the bowel wall benefit from surgical removal before potential spread, while advanced cases may need surgery as part of a comprehensive treatment plan.
Benefits of Colorectal Cancer Surgery
Colorectal cancer surgery offers several distinct advantages in treating and managing the condition:
Surgical Techniques
The type of surgical approach chosen depends on factors including cancer location, stage, and patient characteristics.
Open Surgery (Traditional Colectomy)
This approach involves making a longer incision in the abdomen to access the colon or rectum directly. The surgeon can directly visualise and handle the tissues, which may be necessary for complex cases or when extensive tissue removal is needed. Open surgery allows for thorough examination of the abdominal cavity for signs of cancer spread.
Laparoscopic Surgery
This technique uses several small incisions through which special instruments and a camera are inserted. The surgeon views the operation on a video screen while performing the procedure. Laparoscopic surgery typically results in less post-operative pain, smaller scars, and faster recovery times compared to open surgery. The procedure maintains the same oncologic principles as open surgery.
Robotic Surgery
Robotic-assisted surgery employs sophisticated technology where the surgeon controls robotic arms from a console. The system provides enhanced 3D visualisation and precise control of surgical instruments. This approach offers advantages for operating in confined spaces like the pelvis, particularly for rectal cancers. The robotic system allows for better manoeuvrability in tight spaces.
Surgery Preparation
Medical Evaluation
Blood tests, chest X-rays, and ECG assess overall health status and identify potential complications. Additional imaging, such as CT scans or MRIs, helps determine the extent of cancer and guide surgical planning. A thorough review of medical history and current medications helps tailor the pre-operative plan.
Medication Adjustments
Blood-thinning medications typically need to be stopped several days before surgery. Certain medications may need adjustment or temporary discontinuation based on individual health status.
Bowel Preparation
A clear liquid diet begins 24-48 hours before surgery. Laxatives or enemas may be prescribed to empty the bowel completely. Specific timing for stopping all food and drink intake will be provided. Antibiotics might be given to reduce infection risk.
Lifestyle Modifications
Smoking cessation is advised at least two weeks before surgery to improve healing. Regular exercise within limits helps maintain strength for recovery.
Step-by-Step Procedure
Anaesthesia Administration
General anaesthesia is administered through an IV line. Monitoring devices are attached to track vital signs throughout the procedure. The anaesthesia team maintains proper sedation and pain control during surgery.
Surgical Access
The colorectal surgeon creates either a single large incision or multiple small incisions based on the chosen surgical approach. Proper positioning and sterile preparation of the surgical site occur. The abdominal cavity is carefully examined for any signs of cancer spread.
Cancer Removal
The affected portion of the colon or rectum is carefully separated from surrounding tissues. Blood vessels supplying the segment are sealed and divided. Lymph nodes in the area are removed for cancer staging. A margin of healthy tissue on either side of the tumour is included in the removal.
Intestinal Reconstruction
The healthy ends of the intestine are reconnected using sutures or surgical staples. In some cases, a temporary colostomy might be created if immediate reconnection isn’t advisable. The surgical team ensures proper blood supply to the connected segments.
Closure
All surgical instruments are accounted for before closing. The incisions are closed in layers using appropriate suture materials. Sterile dressings are applied to the wound sites.
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Post-Surgical Care
- Immediate Post-operative Care: Pain management begins with appropriate medications through IV or epidural routes. Nurses monitor vital signs, wound sites, and bowel function regularly. Early mobilisation starts within 24 hours of surgery when appropriate, beginning with sitting up and progressing to walking.
- Hospital Recovery Period: Oral intake progresses from ice chips to clear liquids and then to solid foods as bowel function returns. Physical therapy helps with mobility and preventing complications. The typical hospital stay ranges from 3-7 days, depending on the surgical approach and individual recovery progress.
Potential Risks and Complications
While the risks associated with colorectal cancer surgery are generally low, it is a major procedure, and some complications may occur.
- Infection: Occurs in 5-10% of cases at the surgical site.
- Bleeding: May require additional treatment or a blood transfusion.
- Anastomotic Leak: A 2-4% risk where reconnected bowel segments may separate, needing urgent care.
- Blood Clots: Can form in the legs or lungs, but preventive steps significantly reduce this risk.
- Bowel Changes: Temporary issues like altered bowel habits or difficulty controlling movements may happen.
- Injury to Nearby Organs: Rarely, the bladder or other organs could be affected.
- Long-term Risks: Adhesions or bowel obstruction could develop over time.
Frequently Asked Questions
How long until I can return to work?
Return to work typically takes 4-8 weeks, depending on job requirements and recovery progress. Physical labour jobs may require longer recovery periods, while desk jobs might allow earlier return with appropriate modifications.
What dietary changes should I expect after surgery?
Initially, a low-fibre diet helps reduce strain on the bowel. Gradually, most patients return to their normal diet within 4-6 weeks. Some individuals may need to adjust their eating habits based on their specific surgery type and recovery.
Will I need a permanent colostomy?
Most colorectal cancer surgeries do not require permanent colostomies. The need depends on tumour location and other surgical factors. When necessary, temporary colostomies can often be reversed after 3-6 months.
How often will I need follow-up appointments?
Initial follow-up occurs within 2 weeks after discharge. Subsequent appointments typically follow at 3-month intervals for the first year, then gradually decrease in frequency based on recovery and cancer surveillance needs.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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Our Clinic Locations
Ark Surgical Practice – Mouth Elizabeth Medical Centre
3 Mount Elizabeth, #17-01
Singapore 228510
Monday to Friday: 9am – 5pm
Saturday: 9am – 12:30pm
Sunday & Public Holidays: Closed
Ark Surgical Practice – Mount Elizabeth Novena Hospital
38 Irrawaddy Road, #09-34
Singapore 329563
Monday to Friday: 9am – 5pm
Saturday: 9am – 12:30pm
Sunday & Public Holidays: Closed