About surgery for rectal cancer

Surgery is the most common treatment for rectal cancer.

You may have radiotherapy or chemoradiation before surgery. This can make it easier to remove the cancer. It also lowers the risk of the cancer coming back in the rectum or in the tissues close to it.

There are different techniques and types of operation that can be used. The type your surgeon recommends will depend on the stage of the cancer, where it is in the rectum and your general health.

There are things you can do before surgery to help you prepare.

After the operation, all the tissue that the surgeon has removed will be sent to a pathologist. They will check the tissue carefully for any cancer cells close to the cut ends (the margins). If they find cancer cells in the margins, it is possible that not all of the cancer was removed during the operation. This is not common, but if it happens you may be offered a second operation or radiotherapy.

We have more information about what to expect in the days after surgery for rectal cancer.

Local resection

Very small, stage 1 rectal cancers can sometimes be removed using a local resection. This is a small operation to remove the cancer and some healthy tissue surrounding it.

The surgeon inserts an endoscope into the rectum to remove the cancer. An endoscope is a long, flexible tube with a tiny camera at the end. This surgery is called transanal endoscopic micro surgery (TEMS).

If the cancer is very low in the rectum and close to the anus, the surgeon may not need an endoscope. They may be able to remove the cancer by passing surgical instruments up the anus. This is called a transanal rectal resection.

Total mesorectal excision (TME)

Total mesorectal excision (TME) is the most commonly used operation to remove rectal cancer. The surgeon removes the part of the rectum that contains cancer, as well as some healthy bowel on either side. They also remove the fatty tissue (mesorectum) around the rectum, which contains blood vessels and lymph nodes. Removing the mesorectum reduces the risk of any cancer being left behind.

In the diagram below, the black dotted line shows an example of the tissue that may be removed during a TME operation. There are different types of TME operation.

The large bowel and mesorectum

Open or laparoscopic surgery

Your operation may be carried out as open surgery or as laparoscopic (keyhole) surgery.

Open surgery means the surgeon makes one large cut (incision). Afterwards, you have a wound that goes down in a line from just below your breastbone (sternum) to just below the level of your tummy button (navel). Some people have a wound that goes across their tummy (abdomen) instead.

In laparoscopic surgery, the surgeon makes four or five small cuts in the tummy rather than one big cut. They pass a laparoscope into the tummy through one of the cuts. A laparoscope is a thin tube containing a light and camera. They then pass specially designed surgical tools through the other cuts to remove the cancer.

A surgeon performing laparoscopic surgery

Laparoscopic surgery is sometimes used when the cancer is small. It uses a specialised technique and is not available in all hospitals. If this surgery is the best type for you to have, you may be referred to another hospital to have it done. Recovery from laparoscopic surgery is usually quicker than recovery from open surgery. Your surgeon will talk to you about which type of surgery is likely to be best in your situation.

Stomas (colostomy or ileostomy)

During the operation to remove the cancer, an opening is sometimes made through the tummy (abdominal) wall. This lets the bowel connect to the surface of the tummy. It is called a stoma.

Stomas can be temporary or permanent. A surgeon may make a temporary stoma to allow the bowel to heal after surgery.

If you need to have a stoma, you will be referred to a stoma nurse who specialises in stoma care.

Stoma reversal

If you have a temporary stoma, you can usually have an operation to reverse the stoma when your treatment is over. This means you will pass poo (stools) from your bottom again.

The timing of a stoma reversal operation varies from person to person. It can range from a few months after the stoma was made, to one or two years later.

How stoma reversal is done depends on whether you have a loop stoma or an end stoma.

To reverse a loop stoma, the surgeon closes the opening in the loop of bowel that was used. They then remove the stitches holding the loop of bowel in place on the skin. The bowel goes back inside the tummy (abdomen).

To reverse an end stoma, the surgeon removes the stitches that are holding the piece of bowel up to the skin. The piece of bowel is rejoined to the rest of the bowel inside the tummy.

After a stoma reversal, it may take some time for your bowel habit to get back to normal.

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