An Overview of Rectal Cancer Surgery

The goal of rectal surgery is to cut out all of the cancer. This begins with the removal of the tumor in the rectum and may include the removal of surrounding lymph nodes. When considering what kind of rectal surgery is needed, you and your health care team will consider four main things:

• First, they need to know how close the cancer is to other organs in the pelvis, in other words, its location.

• Next, they will consider how to remove the cancer, while at the same time keeping bowel and sexual functions as normal as possible.

• A third factor that goes into the decision of which surgical technique to choose is the preference for not having a permanent colostomy. A colostomy is an intervention in which the surgeon makes a special hole, called a stoma, from the colon to the surface of the skin. In that way, a colostomy provides an alternative route for the body to eliminate stool.

• The final factor is the experience of the surgeon and the medical facility. It is important to consider how much and what kind of surgery is performed by the surgical team at that hospital.

Types of Rectal Cancer Surgery

Depending on the size and location of the tumor, the surgical team will choose from two main types of rectal cancer surgery: Local Excision and Partial Resection

Local Excision

With local excision a small tumor is cut out of the interior surface of the rectum. This is similar to removing a suspicious growth on the skin.

The surgeon cuts out the diseased tissue along with some healthy tissue. All the removed tissue is examined right away to get an immediate sense of how aggressive the cancer might be. If it appears very active, more surgery or other treatment, such as radiation or chemotherapy, may be recommended.

All tissues will be sent to the laboratory for a complete evaluation. They will be examined under a microscope by a clinical pathologist. This medical specialist is trained to study disease under laboratory conditions.

Partial Resection

Partial resection for rectal cancer is a surgical procedure to remove the cancer. The surgeon cuts the rectum crosswise. The cancerous tissue and its margins are cut out. Then the surgeon joins the cut ends of the rectal tube back together.

The three main types of partial resection are usually referred to by their initials:

• TME stands for Total Mesorectal Excision
• LAR means Low Anterior Resection
• APR stands for Abdominoperineal Resection

Pre-surgical Radiation

Depending on the size and other characteristics of the tumor, radiation may be performed before the surgery is scheduled as a way to shrink the size of the tumor. This may make it easier to remove the entire tumor, which is the goal of rectal cancer surgery.

After Surgery

Decisions about further surgery and other post-surgical treatments, like radiation and chemotherapy, will be based on the microscopic examination of the margins or edges of the tissue specimen removed from the rectum. If cancer is found in the margins, they are said to be involved. Otherwise they are said to be clean or uninvolved margins. If there are involved margins the health care team may consider a partial resection, as well as additional radiation and/or chemotherapy.