• Joel Bauer MD
  • Stephen Gorfine MD
  • David Chessin MD
  • Daniel Popowich MD

Rectal Resection for Cancer

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
  • Pain
  • Obstruction
  • 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.

Diagnosis

Rectal cancer is diagnosed using a combination of the following:

  • Patient history
  • Physical examination
  • Endoscopy
  • Radiology
  • Pathology

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.

Treatment

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 colostomy.

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 be recommended.

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 procedure.

Preparation

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.

Operation

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 resection (LAR).

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.

Postoperative Care

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.

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