How Is Colon Cancer Surgery Performed?

Getting a diagnosis of colon cancer can be scary. But there is some good news — most people who are diagnosed early have good outcomes with surgery. Surgery is the most important part of colon or rectal cancer treatment, and it helps to know what to expect going into it.

Here are some things you need to know about your options for surgery with colon cancer. 

When is surgery recommended for colon cancer?

Surgery is recommended for most stages of colon cancer. The stage of a cancer depends on its size and location, and whether it has spread (called “metastasis”). Staging helps your providers decide the best way to treat your disease. 

Colon cancer is staged from 0 through 4. The higher the number, the greater the burden of the cancer in your body. Stage 1 and 2 cancers are localized to the bowel wall, and stage 3 cancer involves surrounding lymph nodes. Stage 4 means that the cancer has spread beyond the colon to a distant organ, like the lungs or liver.

For stages 1 to 3, surgery is the main treatment for most cases. Surgery may also be recommended for some people with stage 4 disease, depending on where the cancer has spread. 

What are the types of surgeries for colon cancer? 

“Colectomy” is the term used for surgery to remove part or all of the colon. Your surgeon will also remove the lymph nodes surrounding the tumor. There are different types of colectomies, depending on how much of the colon is being removed:

• Partial colectomy: This refers to removal of only part of the colon. It’s also called a “hemicolectomy” or “segmental resection.” 

• Total colectomy: This refers to removal of the entire colon. 

When possible, your surgeon will reconnect the remaining, healthy sections of colon after performing a colectomy. This is called “anastomosis,” and it allows your digestive system to return to normal as quickly as possible. 

Sometimes it may not be possible to reconnect the remaining sections of colon. If this isn’t  possible, they will create an opening from the colon to the abdominal wall. This is called an “ostomy,” and it allows your bowel contents to exit your body.   

Colectomies can be performed in three different ways: 

1. Conventional or “open” surgery requires a long incision over your abdomen. This is performed less frequently due to longer recovery times. 

2. Laparoscopic surgery requires much smaller incisions, or ports. A camera connected to a video monitor is inserted through one of these ports, and the surgery is performed with long instruments inserted through the other ports. Laparoscopic surgery decreases pain from surgery and allows for faster recovery.  

3. Robotic surgery is a new technique that also uses small incisions. Similar to laparoscopy, your surgeon operates with tiny instruments, and a camera provides a magnified view inside your body. 

How successful is colon cancer surgery?

Surgery by itself can cure most people with stage 1 disease. The survival rates are lower with more advanced stages of colorectal cancer. This is why additional treatment is important in these scenarios. 

What other treatment options may be combined with colon cancer surgery?

Surgery alone cannot cure advanced stages of colon cancer. But adding other therapies can help improve chances of successful treatment:

• Chemotherapy: This refers to medications that kill cancer cells or stop them from growing. A common chemotherapy regimen used in colon cancer is FOLFOX. Chemotherapy may be adjuvant (given after colectomy) or neoadjuvant (given before colectomy). Neoadjuvant chemotherapy can shrink the lesions before surgery. This may help the surgeon to reconnect the colon after removing the cancer during surgery. With stage 4 colon cancer, chemotherapy may be recommended instead of surgery.

• Immunotherapy: This treatment uses the person’s own immune system to fight the cancer. Immune checkpoint inhibitors are an example of immunotherapy. They are used to enhance or restore the body's immune defenses against cancer cells. 

• Targeted therapy: These medications selectively destroy cancer cells and spare healthy cells. They have fewer side effects than traditional chemotherapy. They interfere with signals that help the cancer to grow and spread.   

• Radiation therapy: This uses high doses of radiation to kill cancer cells. It isn’t commonly used in colon cancer, but it can shrink tumors that have spread outside the colon.

What risks are associated with colon cancer surgery?

Although rare, colon cancer surgery can cause severe complications or problems after surgery. Some common ones include:

• Bleeding: Several blood vessels must be cut during surgery in order to remove a part of the colon. Sometimes these vessels bleed after surgery and may need a blood  transfusion or a return to the operating room to stop the bleeding.

• Anastomosis leak: A leaky anastomosis can cause infection. A leak can be minor, or it can be serious and life-threatening. It may require antibiotics, a drain in the skin, or even another surgery.

• Damage to surrounding tissues: Damage to the ureter (the tube that carries urine from the kidney to the bladder) can cause urinary problems. 

• Incisional hernia: Sometimes organs can go through the incision sites and create a hernia. 

• Gastrointestinal system problems: Sometimes there’s a delay in the remaining intestines getting back to normal.  

What’s the recovery period like following colon cancer surgery?

In general, recovery after a colectomy is faster with a laparoscopic or robotic procedure. Most people are discharged from the hospital 3 to 5 days after surgery. 

Your care team will explain your after-surgery instructions and make sure you’re set up for a smooth recovery. But here are a few things to expect:

• Activity: You may need to take up to 4 weeks off work, depending on the type of work you do. It’s important to avoid strenuous activity for the first 6 to 8 weeks after surgery. This includes not lifting anything heavier than 10 pounds. Intense exercise is not recommended, but walking is a great way to regain your stamina. It will also decrease your risk for a blood clot and help prevent pneumonia. 

• Diet: You can usually start eating right after surgery, with some restrictions. Raw fruits and vegetables (which are high in fiber) are harder for your healing bowels to digest. So you’ll need to avoid them for about a month.

• Hydration: You may have more bowel movements compared to before surgery. This is because a shorter colon doesn’t absorb fluid as well. So it’s important to make up for the fluid you’re losing through bowel movements. This is especially important if you are having diarrhea. Sometimes your surgeon will prescribe a fiber supplement to make the stool more solid.

• Colostomy: A colostomy is an artificial opening that is usually temporary. It may be needed after any colon or rectal surgery. Its purpose is to allow the tissues in your bowel to heal before they are reconnected. Waste will be collected in a bag outside of the body. Even if the stoma (opening) is temporary, it can still be a big adjustment. Your treatment team will teach you how to care for it. 

Why trust our experts?

Written by:

Merin Kuruvilla, MD

Merin Kuruvilla, MD, is a board-certified allergist/immunologist at Emory University in Atlanta. She has authored several peer-reviewed publications in the field.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Reviewed by:

Sarah Koller, MD, MS, FACS

Sarah Koller, MD, MS, is board-certified in general surgery and colorectal surgery. She is currently on faculty at the University of Southern California as an assistant professor of surgery.

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