Colectomy
Colectomy
Definition
Colectomy is the surgical removal of all or part of the colon, the first part of the large intestine.
Purpose
Doctors perform colectomy to remove large Stage I colon cancer lesions or to cure colon cancer that: has spread beyond the mucous membrane, has infiltrated or spread beyond the intestinal wall, or is likely to recur.
Doctors also perform this procedure to improve patients' quality of life by relieving pain and preventing bleeding and other symptoms that occur when colon cancer invades organs near the bowel, and also, when non-surgical methods are unsuccessful, to treat diverticulitis, ulcerative colitis, and benign colon polyps.
Precautions
This surgery can significantly diminish bowel control and sexual function.
Description
Colectomy is the preferred therapy for colon cancers that can be cured. Performed in a hospital, under general anesthesia, this procedure involves removing the cancerous part of the colon, a margin of normal bowel, and any tissue or lymph nodes affected by the disease, and reconnecting the healthy segments of the colon (anastomosis). If infection or obstruction make it impossible to reconnect the colon, the surgeon creates an opening (stoma) in the abdominal wall (colostomy ) through which feces passes from the body into a disposable collection bag.
Colostomy may be:
- temporary, with the ends of the intestines being reconnected at a later time, or
- permanent in patients whose cancer cannot be completely removed.
Open and laparoscopic procedures
Traditional, or open, colectomy is an invasive procedure requiring a wide surgical incision. This surgery allows the surgeon to view the internal organs very clearly.
Laparoscopic colectomy requires only a few small incisions, enables doctors to view the internal organs, and results in a shorter hospital stay and fewer side effects. Studies suggest that laparoscopic colectomy may be safer than open surgery for elderly patients. A clinical trial funded by the National Institutes of Health (NIH) is comparing survival rates for the two procedures.
Types of colectomy
LEFT RADICAL HEMICOLECTOMY.
Doctors perform left radical hemicolectomy to remove cancer and other abnormal tissue in the:
- descending colon, which extends from the pelvis to the spleen,
- and splenic flexure, the place where the descending colon joins the part of the large intestine that extends across the middle of the abdomen (transverse colon).
When cancer is found in the splenic flexure, the surgeon removes the splenic flexure, the first half of the descending colon, and about one-third of the transverse colon.
RIGHT RADICAL HEMICOLECTOMY.
Doctors perform this procedure to remove tumors and other abnormalities of the:
- section of large intestine nearest the appendix (cecum)
- portion of the large intestine that extends along the right side of the body from the small intestine to the transverse colon (ascending colon).
This procedure involves removing the cecum, descending colon, the hepatic flexure where the ascending colon joins the transverse colon, and the first one-third of the transverse colon. These procedures are considered radical because they involve removing nerves, blood vessels, and lymph nodes near the tumor.
TRANSVERSE COLECTOMY.
Performed to remove disease in the transverse colon, this procedure includes removing the:
- transverse colon,
- and hepatic and splenic flexures.
SIGMOID RESECTION.
Used to remove cancer in the part of the colon (sigmoid) between the descending colon and rectum, this procedure involves removing the:
- sigmoid colon
- bottom two-thirds of the descending colon
RECTOSIGMOID RESECTION.
Used to remove tumors in the part of the colon (rectosigmoid) just above the rectum (sigmoid flexure), this procedure removes:
- the sigmoid colon
- most of the rectum and surrounding rectal tissue (mesorectum)
Because tumors in this part of the colon usually involve the bladder, uterus, or other organs, the surgeon may insert drainage tubes or a catheter to draw urine from the bladder.
ABDOMINOPERINEAL RESECTION (APR).
This extensive procedure, which may be performed in two parts or by two surgical teams operating at the same time, involves removing the:
- lower sigmoid colon
- rectum
- anus
- nearby lymph nodes, blood vessels, and nerves
Sphincter-saving APR is designed to minimize loss of bowel control by:
- removing only the tumor
- preserving nerves and blood vessels near the tumor.
These specialized procedures involve repositioning the tumor while removing it, can cause shedding of tumor cells, and may not be available in all hospitals.
After completing any of these procedures, the surgeon uses:
- sutures
- clips
- heat and electrical current (electrothermal bipolar vessel sealer)
to tie off the ends of blood vessels before closing the incision.
Preparation
The day before the operation, the patient may consume only clear liquids, and may take nothing by mouth after midnight.
To reduce the possibility of infection, antibiotics are given to the patient the night before the operation.
Aftercare
A patient who has had an open colectomy will spend at least a week in the hospital and experience significant postoperative pain.
A patient who has had a laparoscopic colectomy will spend 4-5 days in the hospital, experience less pain, and resume normal activities within two weeks.
A patient who has had a colostomy must learn to care for the collection bag and keep the area clean. Patients who have had colostomies often worry about:
- not being able to care for themselves
- odors, gas, and leakage from the collection bag
- health problems
- recurrence of cancer
A patient who is depressed about sexual dysfunction, bowel problems, or other aspects of treatment may benefit from professional counseling or from joining a support group.
Risks
Side effects of colectomy include bladder complications, diarrhea , bowel irregularities, urinary urgency, and sexual dysfunction.
Normal results
Most patients experience postoperative pain. Patients who have laparoscopic surgery have less pain than patients who have open colectomy. Some patients require temporary colostomy until normal bowel function returns.
Most of these procedures do not affect sexual function, but rectosigmoid resection can make it difficult for a man to achieve erection during intercourse.
Abnormal results
Extensive surgery can cause:
- infection
- severe pain
- fecal incontinence
- prolonged recovery
Resources
OTHER
Colectomy. <http://www.medterms.com/script/main/art.asp?articlekey=12529>. 20 May 2001.
Colorectal Cancer Treatments. <http://www.cancerfacts.com>20 May 2001
Laparoscopic Colorectal Surgery 20 January 2000. 21 May
2001 <http://www.lapsurgery.com/colectom.htm>.
Surgery & Colon Cancer 5 May 2001<http://www.colorectal-cancer.net/surgerycoloncancer><http://www.colorectal-cancer.net/surgerycoloncancer.htm> 20 May 2001
What Are the Latest Treatments of Colon and Rectal Cancers? June 1999. 20 May 2001. <http://content.health.msn.com/content/dmk/dmk_article_5462002 7gt; 20 May 2001
Maureen Haggerty
KEY TERMS
Diverticulitis
—Inflammation or infection in pockets/pouches that primarily develops in the wall of the large or small intestine.
Hemicolectomy
—Surgical removal of half of the large intestine.
Hepatic
—Of the liver.
Ulcerative colitis
—Chronic inflammation of the large intestine and rectum.
QUESTIONS TO ASK THE DOCTOR
- Which type of colectomy should I have?
- How will I feel and look after the operation?
- If I have to have a colostomy, will people be able to tell I'm wearing a bag?