Surgery for Rectal Cancer
Overview
We can treat rectal cancer without surgery. But surgery is the most common treatment for many stages of rectal cancer.
A few things affect which surgery, if any, is the right treatment for you. They include:
- How far the cancer has spread.
- Your family history and genetic risk.
- Your personal preferences.
If you need surgery, our surgeons will try to use minimally invasive methods that do less harm to the body. This includes laparoscopic or robotic surgery that’s minimally invasive. You may recover faster, with fewer side effects. Surgery may sometimes be used along with other therapies.
Surgery for rectal cancer can be a challenge. The pelvis has many narrow parts, making the area hard to operate on. It also has the nerves that affect how you go to the bathroom, and your sexual health. Some rectal cancer is likely to come back after surgery.
Rectal cancer treatment without surgery
At MSK, about half of the people with rectal cancer can avoid surgery to have their rectums removed. Instead, we use a treatment method called watch-and-wait.
MSK helped pioneer watch-and-wait therapy for rectal cancer. This treatment is also known as nonoperative management.
MSK researchers have shown that for some people with rectal cancer, chemotherapy and radiation may kill the tumor. You will not need surgery.
MSK has been studying the watch-and-wait approach since the early 2000s. Our doctors are experts in this method. Watch-and-wait has about the same long-term results as surgery, but with fewer side effects and complications (problems).
This method is best for people who have local rectal cancer tumors. These are tumors that have not spread outside the rectum to other organs.
Our rectal cancer surgeons are experts in the latest surgery methods. Connect with our Care Advisors to start planning your care.
Types of surgery for rectal cancer
There are a few types of rectal cancer surgeries. Your surgeon will talk with you about which type you’ll have. We explain some surgeries in this section.
Surgery alone often is the treatment for rectal cancer tumors that have not spread to other organs.
You may have chemotherapy, radiation, surgery, or a mix of these treatments. When rectal cancer starts to spread, the treatment is chemotherapy and radiation (chemoradiation) along with surgery.
Your surgeon will aim to remove a tumor through the anus without removing the whole rectum. When that’s not possible, your surgeon will try to remove the tumor with the least amount of surgery.
Words you may hear about rectal cancer surgery
- Ostomy
-
An ostomy (OS-toh-mee) is an opening created during surgery. An ostomy can be made out of the small intestine (ileostomy) or colon (colostomy). An ostomy can be temporary, for just a few months or weeks. Or it can be permanent, for all of your life.
- Ileostomy
-
An ileostomy (IL-ee-OS-toh-mee) is when your surgeon brings a piece of your intestine to the outside of your abdomen (belly).
An ileostomy changes the way stool (poop) comes out of your body. It will now come through the ostomy. An ileostomy can be temporary, for just a few months or weeks. Or it can be permanent, for all of your life.
- Colostomy
-
A colostomy (koh-LOS-toh-mee) is when your surgeon brings a piece of your colon to the outside of your abdomen (belly). A colostomy changes the way stool (poop) comes out of your body.
Some people have a colostomy for a few weeks or months while their body heals. Others need one for life, called a permanent colostomy.
These types of colostomies connect parts of your colon to the wall of your belly:
- A sigmoid colostomy connects the sigmoid colon and is the most common type.
- A descending colostomy connects the left colon.
- A transverse colostomy connects the transverse colon and often is temporary.
- Stoma
-
A stoma is the part of your intestine or colon that’s on the outside of your body. It will look red and moist, like the inside of your mouth. Your stoma will be swollen right after surgery, but it will get smaller in 6 to 8 weeks.
- Colostomy or ostomy pouching system (bags)
-
Pouching (bag) systems are worn over an ostomy. These bags are also called colostomy bags or ostomy bags. They’re waterproof pouches made up of a skin barrier (wafer) and a collection pouch.
Instead of pooping like you did before, your poop collects in a bag on the outside of your body. This pouch attaches to your abdomen (belly). It fits over and around your stoma to collect stool.
People who need a permanent colostomy will use a bag to collect stool for the rest of their lives.
A stoma after a colostomy.
The rectum, anus, and colon.
Polypectomy or a local excision during a colonoscopy
When rectal cancer is found early, it’s often just an abnormal (not normal) growth. This is called a polyp. The cancer may be in the polyp.
Removing polyps during a colonoscopy is called a polypectomy (pol-uh-PECK-tuh-mee). It may be the only rectal cancer treatment you’ll need. You may also hear it called a local excision (ek-sizh-uhn).
A polypectomy is when your doctor places a flexible tube, called a colonoscope, into your rectum. The scope lets them see inside your anus and rectum. The scope is connected to a video monitor.
What happens during a polypectomy:
Your doctor passes a wire loop through the colonoscope. The loop has an electric current that can cut any polyps from the rectum wall, stopping them from becoming cancer.
Local transanal resection or excision surgery
A local resection is also known as a transanal excision (TAE). TAE surgery is for early-stage rectal cancer, and removes small tumors that have not spread. Your surgeon removes the tumor and a little rectal wall tissue around it to get all the cancer cells.
Most people have normal bowel action (being able to poop) after a local resection. You will not need a colostomy bag.
In rare cases, TAE can cause problems with how well you can control your bowel. Your care team can offer special tools or treatments to get you back to normal as soon as possible.
Transanal endoscopic microsurgery (TEM)
This procedure removes early-stage rectal cancer using a scope put into the anus.
TEM often takes less time than standard abdominal surgery. You can go home soon after the procedure. It does not harm nearby nerves that affect how you can go to the bathroom and your sexual health.
People who have TEM do not need a colostomy.
There are other benefits to TEM:
- It’s ideal for older people with health conditions that make it harder to have longer, complex surgery.
- It often has fewer complications (problems)
- It has a faster recovery time.
Rectal cancer APR and LAR proctectomies
A proctectomy is surgery to remove all or part of your rectum. The 2 types of proctectomy surgery are an abdominoperineal resection (APR) and a low anterior resection (LAR).
An abdominoperineal resection (ab-DAH-mih-noh-PAYR-ih-NEE-ul ree-SEK-shun) treats rectal cancer that’s very low in the rectum. Most often, it’s done when the tumor is very close to the anus. APR surgery removes the anus, rectum, sphincter muscles, and part of the sigmoid colon (lower colon).
APR is a type of surgery called a total mesorectal excision (TME). TME removes most or all of the rectum and nearby tissue.
APR surgery can be done by open or minimally invasive methods, and in general takes about 2 to 3 hours. You’ll be in the hospital for a few days.
Open surgery is when your surgeon makes 1 long incision (cut) on your abdomen (belly).
Minimally invasive surgery is when your surgeon makes a few small incisions. They’ll put small surgery tools and a video camera into the incisions.
Because your rectum and anus will be removed, you’ll need a new place for your stool (poop) to leave your body. You’ll have a permanent colostomy during APR surgery. You’ll need to have a colostomy pouch (bag).
It takes about 3 to 6 weeks to recover from APR surgery.
LAR surgery treats stage 1, 2, or 3 rectal cancers. LAR surgery removes the lower or middle part of your rectum, then reconnects the rest of your rectum to your colon. This surgery aims to keep your sphincter muscles.
LAR surgery often takes about 4 hours, and can be done by open or minimally invasive methods.
Open surgery is when your surgeon makes 1 long incision (cut) on your abdomen (belly). They’ll remove the part of your rectum with cancer through the incision.
Minimally invasive surgery is when your surgeon makes a few small incisions. They’ll put small surgery tools and a video camera into the incisions to remove the cancer.
Your surgeon often will know before surgery if you’ll need a temporary ileostomy. You may need to have an ileostomy for a short time after LAR surgery. The ileostomy will be closed a few months after your surgery.
You’ll be able to have bowel movements (poop) as usual after you heal. Very few people need a permanent ileostomy or an ostomy pouch.
Total pelvic exenteration surgery
A total pelvic exenteration (eg-ZEN-teh-RAY-shun) is complex surgery to remove the rectum and nearby organs that have cancer. This can include your bladder, uterus, or prostate.
Because your rectum and anus will be removed, you’ll need a new place for your stool (poop) to leave your body. You’ll need a colostomy pouch (bag).
During your surgery, the lower end of your colon will be brought outside your body through the skin on your abdomen. This is called a colostomy.
Research shows that surgeons at centers that do a high volume of surgeries have better results. MSK’s rectal cancer surgeons are among the world’s most experienced. Each year we care for more than 1,200 people with colon and rectal cancer. We treat every kind of rectal cancer, including the rarest types.
At MSK, almost everyone with rectal cancer can avoid a permanent colostomy because we use the latest surgery methods.
Many people with rectal cancer do not need a colostomy or colostomy bag. It depends on the stage and location of the rectal cancer. Out of every 100 people with rectal cancer, between 15 and 40 will not need a colostomy or colostomy bag.
If you need a colostomy, most often it’s reversed (changed back) after a short time. Your surgeon will reconnect the 2 ends of the colon. You can go back to how you used the bathroom before surgery.
For a few people, the colostomy may be permanent. You’ll wear a pouching (bag) system over your ostomy to collect stool. The bag attaches to your abdomen and is fitted over and around your stoma to collect your stool.
It’s natural to feel anxious about this big change. An MSK wound, ostomy, continence (WOC) nurse will support you after rectal cancer surgery as you adjust to having a colostomy or colostomy bag.
Open surgery for rectal cancer
Traditional surgery is often called open surgery. Your surgeon does a single incision (cut) large enough to operate using their tools by hand.
You’ll be in the hospital for 2 to 5 days to recover from this type of surgery.
In general, people who have open surgery or minimally invasive surgery have similar long-term results.
Minimally invasive rectal cancer surgery
MSK surgeons are experts in surgery methods that do less harm to your body. Minimally invasive surgery does less harm to your body because it’s done with small incisions (cuts).
Minimally invasive surgery methods are laparoscopy and robot-assisted surgery.
At MSK, we use minimally invasive surgery methods for some rectal cancer operations. We use it when a tumor is farther from the anus, or if it cannot be reached with open surgery.
Benefits of minimally invasive surgery for rectal cancer include:
- Less loss of blood.
- A shorter hospital stay.
- A faster recovery.
- Less scarring.
- Less pain.
- Less risk of infection.
- Fewer complications (problems) during and after surgery.
- Less risk than regular surgery for people with other health conditions.
MSK does hundreds of minimally invasive surgeries each year. It’s one of the busiest cancer centers for these procedures.
Laparoscopic (LA-puh-ruh-SKAH-pik) surgery is called a laparoscopy. Your surgeon uses a laparoscope, a thin tube with a light and video camera at its tip.
They put the laparoscope through a small cut in the wall of the abdomen (belly). It lets your surgeon see the images from the laparoscope on a television monitor. Laparoscopy uses special instruments to remove the rectal cancer tumors and areas with cancer.
With robotic-assisted surgery, your surgeon uses the da Vinci® Surgical System. They sit at a console and control a robot that moves the surgical tools. There are hand, finger, and foot controls.
The surgical tools remove areas with cancer.
The console has a special monitor where they can see very clear, 3D images from a special flexible tool inside your rectum. Your surgeon can see and remove a tumor. MSK’s operating rooms have the latest technology, including 11 robotic platforms.
MSK leads the nation in doing the most colorectal robotic surgeries. Our surgical skills with this technology come from many years of experience. MSK surgeons do more than 700 robot-assisted colorectal surgeries each year. Almost half of our surgeries for colorectal cancer are done robotically.
Tools for predicting rectal cancer survival and cancer coming back
MSK’s online prediction tools (nomograms) predict rectal cancer 5-year survival rates and the chance of recurrence after rectal cancer treatment. Our clinical calculators can help your doctor and you make important decisions about treatment and your follow-up care.
One rectal cancer nomogram predicts whether you’ll have no signs of rectal cancer 5 years after your treatment. It also predicts the chance you’ll survive rectal cancer at least 5 years after treatment. This tool is for people who had chemotherapy, radiotherapy, and surgery for rectal cancer.
Another rectal cancer nomogram predicts the chance you’ll have no signs of rectal cancer 5 years after your treatment. It’s for people who had total neoadjuvant therapy, which combines chemotherapy and radiation therapy. You must also have had surgery or watch-and-wait active surveillance..
Learn more about our rectal cancer prediction tools.
Common questions
You may have many questions if your care team recommends surgery for rectal cancer. Here are some examples.
- What surgery do you recommend for me and why?
- Will I need other treatments before or after surgery?
- How long will I be in the hospital?
- When will I know the results of my surgery?
- What are the risks and side effects? Will any of them be long-term?
- Will I need a colostomy bag after surgery? If so, for how long?
- Are there any special diets or foods I should have or avoid?
- Will I be able to go back to normal activities?
- Can I get follow-up care at MSK’s locations in New Jersey, on Long Island, or in Westchester?
MSK surgeons are experts in ways to help you keep a high quality of life after rectal cancer surgery. We try our best to avoid the need for a colostomy bag. For example, you may have these procedures:
Coloanal (KOH-loh-AY-nul) reconstruction, also called a coloanal anastomosis (uh-NAS-toh-MOH-sis). We remove the rectum and connect the upper colon to the anus.
Colonic reservoir. Your surgeon will loop 2 sections of the lower colon together and open up the wall between them. They build a colon pouch inside your body, called a J-pouch. This reservoir stores waste (poop). You avoid having a colostomy bag.
Chemotherapy and radiation therapy (chemoradiation) before surgery is called neoadjuvant (NEE-oh-A-joo-vant) therapy. It shrinks rectal tumors, making them easier to remove during surgery.
Neoadjuvant therapy is the standard treatment:
- For advanced rectal cancer that hasn’t spread past the rectum.
- For a tumor close to the anus.
The treatment for rectal cancer that has not spread is neoadjuvant therapy, then surgery, then chemotherapy. This cures about 7 out of every 10 people who had rectal cancer that did not spread. The cancer comes back for 1 out of every 10 people.
To help your body heal, you’ll change how you eat for the first few weeks after surgery.
- Eat small meals often. Try to have 6 small meals throughout the day instead of 3 large ones.
- Eat slowly and chew your food well.
- Drink 8 to 10 (8-ounce) glasses (about 2 liters) of liquids every day.
- Eat mostly bland, low-fiber foods.
If you have a colostomy, you can follow these diet guidelines.