Rectal Resection for Cancer
Procedures Performed by Our Manhattan Colorectal Surgeons
Rectal cancer is a very common. Most cases of rectal cancer are asymptomatic
and diagnosed by screening colonoscopy.
Symptoms are not specific to this disease and may include:
- Rectal bleeding
- Weight loss
The cause is unknown, but most cases arise from polyps of the lining of
the colon. Once diagnosed, treatment includes surgical resection of the
involved colon. Depending on the stage, preoperative chemotherapy and
radiation and/or postoperative chemotherapy and radiation may be recommended.
Rectal cancer is diagnosed using a combination of the following:
- Patient history
- Physical examination
The diagnosis is often made using colonoscopy with biopsies. When patients
have endoscopy or surgery for the disease, tissue is often submitted to
the pathologist for evaluation.
Colonoscopy is also important in patients with a history of rectal cancer
for surveillance of the colon for development of tumor recurrence. Radiology
tests that may be ordered include plain X-ray and CT scan of the chest,
abdomen, and pelvis.
These studies are often utilized in the evaluation for evidence of metastatic
disease. Patients may also have an endorectal ultrasound, where a slender
ultrasound probe is inserted through the anus into the rectum to evaluate
the stage of the tumor.
The treatment of rectal cancer varies based upon the local and distant
extent of tumor spread. Based upon the preoperative endorectal ultrasound
staging, preoperative chemotherapy and radiation may be offered. This
is done to shrink the tumor, decrease the rate of local recurrence after
surgery, and increase the chances of the surgery being done without a
If there is no spread beyond the primary site in the colon, the treatment
is often removal of the involved colon. Following removal of the colon,
the pathologist will evaluate the tumor under the microscope and give
it a stage based upon the depth of penetration of tumor in the wall of
the colon and the presence of tumor in the lymph nodes surrounding the
tumor. Based upon the stage of the tumor, postoperative chemotherapy may
In selected patients with limited spread in the liver or lungs, removal
of the involved colon along with the tumor in the liver or lungs may be
feasible. The recommendation for this treatment strategy is individualized
based upon the extent of disease and overall clinical presentation of
the patient. If this approach is chosen, it is common for postoperative
chemotherapy to be administered.
If there is tumor spread beyond the primary tumor and it is not amenable
to removal, surgery may not be recommended. In this situation, chemotherapy
is often administered.
Rectal resection for cancer is often performed to cure the disease or treat
symptoms. It is performed in the hospital and you will be admitted following
The night prior to the procedure, you will be instructed to not eat or
drink after midnight. In addition, you will be prescribed a bowel preparation.
The preparation should be taken as instructed.
You will receive General Anesthesia, so you will be completely asleep and
monitored at all times.
After anesthesia is established, an incision will be made in your abdomen
and the rectum containing the cancer will be identified. The segment of
rectum with the cancer will be removed. Once the diseased rectum is removed,
the two ends may be reconnected. This procedure is called a low anterior
In some cases, when the tumor is very close to or involving the anal sphincters,
an abdominoperineal resection (APR) may be performed. An APR involves
removing the rectum and anus and creating a permanent colostomy.
In very select cases, the tumor may be excised through the anus. This procedure
is called a transanal excision. If this is performed, all the incisions
are internal. There are many factors that contribute to the decision of
the type of resection performed for rectal cancer. Your surgeon will discuss
the options for resection with you at the time of your consultation. You
will have a dressing placed over the operative site.
Following a rectal resection, you will be admitted to the hospital. You
will receive pain medication and intravenous fluid. Once bowel function
returns, as evidenced by passage of gas or stool, your diet will be advanced.
Once you tolerate a diet, and have no signs of fever or other complications
of the surgery, you will be discharged from the hospital. You will be
given a prescription for pain medication and a follow-up appointment within
one to two weeks.
If you have questions,
contact our Manhattan colorectal surgeons at 646.798.4606.