Colorectal Cancer: Proctectomy

A proctectomy can be used at all stages of rectal cancer. How much of your rectum needs to be removed depends on the stage (severity) and location of the cancer. Not everyone with rectal cancer will need a proctectomy. Your healthcare team will work with you to find the treatment that is best for you.

Proctectomy can also treat ulcerative colitis and Crohn's disease.

Before scheduling your proctectomy, your healthcare team may need to do a few tests. These tests will give an idea of your overall health and the stage of your cancer. This will help the team plan for your surgery. You may be asked to get imaging tests, blood tests, an ECG (electrocardiogram), or a colonoscopy.

Once your surgery is scheduled you will need to prep for it. This may include:

• Bowel prep. Your bowels will need to be cleaned out for the surgery. This means you’ll need to make changes to your eating and drinking. You may also need to have laxatives or an enema. Follow all instructions you are given for not eating or drinking before the surgery.
• Antibiotics. You may need to take antibiotics to reduce the potential for infection. You may be given antibiotics through an IV (intravenous) line. This is done right before surgery. It may also be done during surgery.
• Changes in medicines. Be sure to discuss all your medicines. This includes prescription and over-the-counter (OTC) medicines, especially blood thinner medicines. It also means vitamins, herbs, supplements, marijuana, and illegal drugs. You may need to stop taking medicines for a week before your surgery. You also may be asked to stop smoking 2 weeks before surgery. Smoking can delay healing and recovery.

Your healthcare provider will give you prep instructions. You should follow up with any questions and concerns.

During the proctectomy, you’ll be under general anesthesia. This means you won’t be awake or feel pain during the surgery.

Different types of surgery may be done depending on your situation. Ask your provider which type of surgery you will have. Make sure you know what to expect and how your body will look and work after surgery. Options for the surgery include:

• Minimally invasive laparoscopic surgery. During this surgery, your surgeon will work through a few small cuts (incisions) on your belly (abdomen). A tiny camera on the end of a tube is inserted through the cuts to look at the inside of your body on a video screen. Your surgeon uses special long, thin tools to do the surgery. The surgery sometimes is robot-assisted. This is when the surgeon uses a computer to control robotic arms that do the surgery.
• Local resection or transanal excision. This surgery is done through the anus and doesn’t require any belly incisions. You’ll have this surgery if the cancer is lower in your rectum and can be reached through the anus. That means the cancer hasn’t spread too deeply.
• Low anterior resection (LAR). If your cancer is higher and deeper in the rectum, your surgeon may do this surgery. It removes a large part of your rectum through an incision made in your lower belly. This lets the surgeon look for signs that the cancer has spread inside your belly.
• Anastomosis. This is done after parts of your rectum have been removed. It involves reconnecting the ends of healthy rectum tissue. Doing this allows you to have normal bowel movements through your anus. Not everyone can have this surgery. If you have it, the pattern of your bowel movements will likely change. This includes how often you go and how solid your stools are.
• Abdominoperineal resection (APR). If your rectal cancer is close to the anal opening and large, you may have this surgery. For APR, the rectum is removed and the anal opening is closed. This surgery requires you to have a colostomy. That’s a procedure that connects your colon to an opening (stoma) made on your lower belly. Your bowel movements are then collected in a bag that covers the stoma.
• Pelvic exenteration. This surgery is only done in rare cases. It removes organs near the colon, such as the bladder, prostate, or uterus. A colostomy is always needed after this surgery.

Some of these surgeries don’t require a permanent colostomy. But sometimes you’ll need a short-term ileostomy to help with the post-surgery recovery. An ileostomy is a procedure to connect part of your small intestine to a stoma. Your stool then comes out of the stoma instead of through your colon and rectum. You may also need this surgery if you’ll have more treatment, such as radiation therapy. Because it is short-term, you’ll need another surgery later to reconnect the intestines and close the ileostomy.

Having a proctectomy may seem like a lot to deal with. But your surgeon will walk you through all steps of the surgery. Remember, you’re not alone in this.

After your surgery, you’ll have instructions to follow both in the hospital and when you go home.

As with any surgery, there are possible risks and side effects. It’s a good idea to keep a side effect journal that you can share with your healthcare team. They will help you to find ways to manage those side effects.

Possible side effects include:

• Bleeding
• Pain
• Infection at the incision site or inside the abdomen
• Blood clots that form in the leg veins and then move to the lungs (pulmonary embolism)
• Leaking inside your body at the joined tissues and vessels
• Trouble peeing
• Trouble pooping
• Inability to control bowel movements (incontinence)
• Wound healing problems or opening of the wound
• Sexual problems
• Reactions to anesthesia
• Scar tissue in the abdomen (adhesions)

There may be other risks, depending on your health. Talk with your healthcare provider before the procedure if you have concerns.

While meeting with your healthcare team about a proctectomy, it can be hard to remember all your questions.

Before you agree to a test or procedure, make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how you will get the results
• Who to call after the test or procedure if you have questions or problems
• How much you will have to pay for the test or procedure