If cancer is confined within a polyp that can be completely removed through the colonoscope, no other therapy may be necessary. However, follow-up colonoscopies at one to three year intervals are advised.
Colectomy The vast majority of people who develop colon cancer will require surgical resection (removal) of a segment of the colon or rectum. During this procedure, known as "colon resection" or "colectomy," the surgeon often eliminates between 8 to 12 inches of the colon.
The adjoining mesentery (a membrane that connects the intestine to the abdomen, and contains both blood vessels and lymph nodes) is removed as well. This is because colon cancers can involve the lymph nodes and invade the blood vessels directly.
Because the colon is on average five feet long and because tumors can develop anywhere along its length, the segment to be removed will vary from patient to patient.
The procedure can be performed either laparoscopically (using small incisions and special miniaturized instruments) or via an open surgery called laparotomy.
Laparoscopic surgery Laparoscopic surgery is the standard of care for the majority of colorectal procedures. The Division of Colorectal Surgery at NewYork-Presbyterian/Columbia University Medical Center uses laparoscopic techniques for 90 percent of its colon surgeries. Compared to open surgery, the benefits of laparoscopy include: less postoperative pain and therefore less pain medication, faster healing for a quicker return home, and smaller, less noticeable scars.
Our surgeons have earned national and international recognition for their expertise in minimally invasive and laparoscopic surgery, and routinely train other surgeons across the country. Our overall surgical outcomes are highly favorable compared to national averages.
During laparoscopic surgery, the surgeon utilizes a small incision through which a "port" is placed to inflate the abdominal cavity with gas. A camera is then introduced through the port to help visualize the inside of the abdominal cavity on a television monitor. Surgery is performed with instruments through additional ports placed via small incisions in the abdominal wall.
After the surgery, the two remaining ends of the bowel are joined together to reconnect the intestine. This reconnection is called an anastomosis.
What is a stoma, and will I need a one?
A stoma, commonly referred to as a colostomy or ileostomy, is an artificial opening in the abdomen created during surgery that allows elimination of stool after the operation. It is necessary if passage to the anus is interrupted after the operation. .The colostomy may be temporary, to give the colon a chance to heal, or permanent (in 10 to 15 percent of cases) if the lower part of the rectum has been removed. In most cases, if a stoma will be permanent, your surgeon will be able to tell you this prior to the procedure. Caring for a stoma is enhanced by specially-trained nurses called "enterostomal" therapists. They help teach you about stoma care, skin care, and appliance management. They can also introduce you to other patients with stomas ("stomates") so that you can learn from their experiences. The length of hospital stay for colorectal surgery varies from 4 to 10 days depending on the individual and the type of surgery.
Our surgeons are also experts in robotic colorectal surgery, an emerging technology which is currently unavailable in most centers. According to Dr. Steven Lee-Kong, the first surgeon trained to perform robotic colorectal surgery at NYP/Columbia, robotic assistance gives colorectal surgeons important technical advantages: "There are nerves in the pelvis that control sexual and bladder function. This technology allows us to more carefully identify and preserve those nerves," he explains. Benefits to patients undergoing colorectal surgery are under study in clinical trials, including a multi-center trial comparing the outcomes of robotic and conventional techniques.
During robotic surgery, the surgeon sits at a console that includes a large, high definition computer screen and controls to manipulate the surgical instrumentation. Across the room at the operating table, narrow arms with tiny surgical tools and a miniature camera are inserted through two to four tiny incisions in the patient’s abdomen. From the console, the surgeon has an excellent magnified view and can move the instrumentation to carefully perform each step of the operation.
More information can be found here: www.columbiasurgery.org/colorectal/index.html