Colorectal Cancer Surgery

The operation removes the segment of large bowel containing the diseased area, along with the fatty tissue and the lymph nodes that share its blood supply, and then joins the two cut ends back together.

How much is removed depends on where the segment sits, because the blood supply, and not the length of bowel, defines the boundaries. An operation on the right side of the colon and one on the left are different procedures with different recoveries. Surgery on the rectum, which sits low in the pelvis surrounded by the nerves controlling the bladder and sexual function, is the most technically demanding of them, and it is often preceded by several weeks of treatment aimed at shrinking the area first.

Most of these operations can now be done by keyhole, through four or five small cuts with a camera, and some centres use a robotic platform for the rectum. Keyhole surgery means less pain and a faster return to eating and walking; your surgeon may still need to convert to an open cut during the operation if the view is inadequate or the anatomy is difficult, and that decision is a safety judgement taken at the time.

A stoma, where the bowel is brought out through the abdominal wall into a bag, is part of this operation for some people. It is usually temporary, to protect a fresh join while it heals, and it is sometimes permanent when the join cannot safely be made. Your surgeon will tell you beforehand whether one is likely and a stoma nurse will mark the site on your abdomen before you go to theatre.

You are admitted a day before. Depending on the segment involved you may be given a bowel preparation to clear the bowel, along with clear fluids and a carbohydrate drink up to a few hours before surgery.

The operation is under a general anaesthetic and takes two to four hours, longer for the rectum. A tube is placed into your bladder to drain urine and is removed after a day or two, and an epidural or a nerve block is often added for pain relief.

You wake in the ward or in a high-dependency bed. Modern recovery protocols move quickly and deliberately: sips of water the same evening, out of bed to a chair on the first day, walking the corridor by the second, and food as soon as your bowel shows signs of working. Passing wind is the milestone the team is waiting for. Most people stay four to seven nights.

Expect six weeks before you feel like yourself, and a good deal less before you are up and about. Walk a little more each day from the first week; it is the single thing that most reduces chest infections and clots.

No lifting anything heavier than a few kilograms for six weeks, since the abdominal wall is healing. Driving is usually possible at three to four weeks, once you can brake hard without flinching. Desk work restarts at four to six weeks, physical work at eight to twelve.

Your bowel habit will be unsettled for weeks to months. Frequent small motions, urgency, and the feeling of not having finished are all expected after surgery on the lower bowel, and they improve gradually over six to twelve months. Eat small, regular meals and build fibre back slowly. The laboratory report is available in about a week and decides whether chemotherapy is recommended, which typically starts six to eight weeks after surgery.