Operations for Rectal Cancer
Operations for rectal cancer are designed to remove all of the cancer present and if possible restore the function of the rectum. Prior to 1997 all rectal surgery in West Sussex was performed by open surgery. Mr Miles brought laparoscopic colorectal surgery to Worthing in 2000 and has led the development of laparoscopic and minimally invasive surgery in West Sussex. Mr Miles is fully trained in both open and laparoscopic rectal surgery
A laparoscopic / minimally invasive approach is now considered in every case of rectal cancer and is possible in more than 80%.
Some small, early rectal cancers may be treated by local excision using the TAMIS technique
Anterior resection for a mid rectal cancer
The operation to remove a cancer can be defined by distance that the cancer is from the anal verge. A cancer which is more than 12cm above the anal verge is called an anterior resection. If the cancer is between 12 and 6cm it is called a low anterior resection and less than 6cm it is called an ultra-low anterior resection. The nearer the cancer is to the anal verge the more difficult the operation and the higher the risk of post operative complications. All of these operations are perfomed so that all of the fat around the rectum, which contains then lymphnodes, is removed. This is called a Total Mesorectal Excision (TME) and is the gold standard for rectal cancer surgery. All operations to remove the rectum perfomed under the care of the East Preston Clinic are TME operations.
Because the operation to remove all of the lymphnodes also removes the blood supply to the remaining rectum there is a risk that the join made to restore the bowel may leak. To protect against this a temporary loop Ileostomy will usually be formed. This will be closed after about 6 weeks. Before the ileostomy is closed an Xray picture of the join is taken to be sure that there are no leaks.
After rectal surgery
Surgery to remove the rectum gives an excellent opportunity to remove the cancer and provide a cure. This is however at the cost of removeing the rectum. The rectum normally stores the stool before defecation. if it is removed there is no space to store the stool and in some patients this can cause significant problems. This is called the Anterior Resection Syndrome and incluedes; urgency, frequency, tenesmus (a feeling of not having completely finished), incontinence and generally erratic bowel habit. If your cancer is very low in the rectum, if you have to have pre-operative radiotherapy or if your surgery has been complicated by a leak you are more likely to suffer some or all of these symptoms. In general 50% of patients who have an anterior resection will suffer some degree of incontience. This must be kept in mind when discussing your treatment.
Continence can improve with time and drugs may be used to control when the bowel is likely to open.
It is because of these problems some patients decide to have a colostomy rather than risk poor function. This is particularly important for some occupations where access to a toilet may be limited.
Soem patients with very low rectal cancers choose to an Abdomino Perineal (AP) resection where the entire rectum is removed and the colon brought out onto the skin as a colostomy.