Surgery is a main and common treatment for rectal cancer. The choice of surgery depends upon the extent and location of the cancer. Surgeon may opt for any of the following procedures after carefully evaluating patient condition and cancer stage to remove or destroy rectal cancers.
Low Anterior Resection Surgery (LAR): It is the most common procedure performed for rectal cancer located above the anus. The procedure involves removal of the entire rectal cancer along with adjacent normal rectal tissue and surrounding lymph nodes. After removal of the cancer, the ends of the rectum are sewn back together.Colon is attached to the remaining part of the rectum.This operation keeps the anal function and patient can pass stools in a normal manner.
Abdominoperineal resection (APR): The procedure is performed for rectal cancer located close to the anus and involves removal of anus. The patient must then use a colostomy bag to collect stool.
Polypectomy and local excision: Superficial cancers or polyps are removed by local excision or polypectomy procedures. The proceduresare performed with instruments inserted through the anus without making an incision in the abdomen.
Local transanal resection (full thickness resection): The procedure is done with instruments inserted through the anus, without making an incision in the abdomen. The surgery involves excision of all layers of the rectum as well as some surrounding normal rectal tissue.
Transanal endoscopic microsurgery (TEM): The procedure is performed for early stage cancers that are locatedhigher in the rectum with the help of a specially designed magnifying scope that is inserted through the anus and into the rectum, to allow the surgeon to do a transanal resection with great precision and accuracy.
Proctectomy with colo-anal anastomosis: Proctectomy is the removal of entire rectum in case ofsome stage I and most stage II and III rectal cancers located in the middle and lower third of the rectum. This is followed by connecting of the colon to the anus (colo-anal anastomosis).
Pelvic exenteration: For rectal cancers that growinto nearby organs, a pelvic exenteration is recommended. This is an extensive operation that involves removal of the rectum as well as nearby organs such as the bladder, prostate (in men), or uterus (in women) if the cancer has spread to these organs. Patient may need colostomy, urostomy etc. after the procedure.
Diverting colostomy: The rectal cancer that blocks rectum is removed to ease the blockage that is causingsevere nausea, vomiting, and belly pain to the patient. The procedure involves cutting of rectum above the tumor and creation of a stoma by the surgical procedure calleddiverting colostomy.
Sphincter-Sparing Treatment: This means thecancer therapy that avoids removal of the anal sphincter for rectal cancers to allow the patient to preserve function of the anus. This involves limited surgery (that removes the cancer and a small rim of normal bowel, but not the anus), followed by a combination of chemotherapy and radiation therapy.
