Colon Cancer Surgery: Different Types, What To Expect, And Recovery After

Colorectal or colon cancer is the third most commonly diagnosed cancer in both women and men in the U.S. According to the American Cancer Society, the estimated number of colon cancer cases for 2021 in the U.S. is 104,270 new colon cancer cases and 45,230 new rectal cancer cases.¹

If you’ve received a colon cancer diagnosis, your doctor might recommend surgery to treat it. The earlier colon cancer is identified and treated, the more chances you have of a positive outcome. Here’s everything you need to know about its treatment through surgery.

Different types of colon cancer surgery

After you’re diagnosed with colon cancer, your doctor will use multiple factors to determine your best treatment option, including where your cancer is located in your colon and if and how far it has spread.

There are two colon cancer surgery approaches² doctors use today:

• Minimally invasive surgery: This type of surgery uses robotic or laparoscopic tools and requires a smaller incision, allowing for a quicker recovery.

• Open surgery: This is the traditional approach that uses an abdominal incision. It might require a longer stay in the hospital.

There are four types of colon cancer surgery treatments: polypectomy and local excision, endoscopic mucosal resection (EMR), laparoscopic surgery, and colectomy.

Polypectomy and local excision

The surgeon can remove certain early (stage 0 and some early stage I) colon cancers and most polyps during a colonoscopy. A colonoscopy is a type of procedure where a long and flexible tube with a small attached camera is inserted into your rectum and eased into your colon.

How it works

Your colon needs to be empty before a colon polypectomy. You might require laxatives, enemas, or both, from 12 to 24 hours before your procedure.

The cancer is removed during a polypectomy. As part of the polyp, it’s cut at the base (it looks like a mushroom stem). The surgeon passes a wire loop through a colonoscope and cuts the polyp off your colon wall with an electric current. It's a relatively quick procedure that takes approximately 20 minutes to one hour to perform, depending on which interventions are needed.

Recovery from a polypectomy typically takes around two weeks.³ You might feel pain after your procedure, especially right after.

Side effects of polypectomy

The potential side effects of polypectomy might include:

• Heavy bleeding

• Chills or fever (which indicates infection)

• Vomiting

• Bloating or severe pain in the abdomen

Endoscopic mucosal resection (EMR)

The EMR is a procedure where the surgeon removes early-stage cancer, precancerous cancer, or other digestive tract lesions (abnormal tissues) from your colon.

How it works

You’ll be sedated during an endoscopic mucosal resection. The surgeon may use special tools during colonoscopy to remove a polyp and a small part of your colon’s inner lining.

An EMR takes around one to two hours, but your visit might last another two to three hours to allow time to prepare for the procedure and for you to recover afterward. Most patients are able to go home the same day after the procedure is completed.

Since there’s no incision, you might recover quicker and experience less pain than you would from laparoscopic or open surgery.

Side effects of EMR

You might experience fairly mild side effects within 24 hours following an EMR, which might include:

• Reactions to the sedative (e.g., nausea, vomiting, and drowsiness)

• Cramps or gas if the surgeon pumps air into your digestive system

• Bleeding

Laparoscopic surgery

Laparoscopic surgery is a minimally invasive procedure. It’s a safe and effective alternative to traditional surgery to treat early colon cancer and is associated with a quicker recovery.

How it works

With this procedure, the surgeon passes several viewing scopes into your abdomen via small incisions (“keyholes”) while you’re under anesthesia. Laparoscopic surgery helps remove the cancer-containing segment of the colon.

There are certain guidelines you’ll need to follow before you come into the hospital for your surgery. These include the following:

• Don’t eat or drink anything, including water.

• Don’t smoke after midnight the day before your procedure.

• Don’t wear jewelry (your wedding rings are fine).

• Wear comfortable shoes on your surgery day. You may be unsteady on your feet and drowsy from the anesthesia.

• Remove any nail polish before your procedure.

• Wear loose-fitting clothes. You’ll experience some abdominal cramping and tenderness after the procedure.

Laparoscopic surgery typically lasts around an hour and a half to three hours.  There are usually smaller incisions and a shorter recovery time with laparoscopic surgery than with traditional colon surgery. You should be able to return to your normal activities within a week or two of your procedure.

Side effects of laparoscopic surgery

Potential side effects of laparoscopic surgery include:

• Abdominal pain

• Fever or chills

• Swelling, redness, drainage at your incision sites, or bleeding

• Inability to urinate

• Nausea or vomiting

• Ileus or your bowel temporarily going to sleep

• Lightheadedness

Colectomy

A colectomy is a type of surgery where the surgeon removes all or part of your colon. Locally advanced cancers require the removal of a segment of the colon. They might also remove nearby lymph nodes.

If surgeons only remove a part of your colon, it’s referred to as a partial colectomy, hemicolectomy, or segmental resection. If they remove all of your colon, it’s referred to as a total colectomy.

Some patients may need a colostomy or an ileostomy bag (an external bag into which feces collects) as a temporary or permanent measure.

How it works

During the colon cancer colectomy, the surgeon will take out the part of your colon with cancer, as well as a small portion of your normal colon. They’ll then reattach the remaining sections of your colon. They’ll remove a minimum of 12 lymph nodes to check for cancer.

A total colectomy isn’t often required to eliminate colon cancer. It’s usually done only if the surgeon finds another problem in the areas of your colon without cancer. A problem could be inflammatory bowel disease or the presence of hundreds of polyps (familial adenomatous polyposis).

Before the procedure, you can expect the following:

• You will need to have your bowels emptied. 

• You might be told to only drink broth or clear liquids the day before your surgery. 

• You might have to do a bowel prep (laxatives and enemas) one to two days before the procedure. 

• You might have to stop taking certain medications the week before your procedure.

A colectomy can take a few hours, depending on what the procedure entails. Recovery time depends on whether you’ve had an open colectomy or a laparoscopic-assisted colectomy. Incisions are smaller with a laparoscopic-assisted colectomy. Therefore recovery time is usually quicker than with open colectomy.

Side effects of colectomy

The potential side effects of colectomy include:

• Internal bleeding

• Reactions to the anesthesia

• Hernia

• Blood clots in your lungs or legs

• Infection inside your belly or at the skin incision site

• A leak where your intestines are sewn together

• Adhesions (scar tissue) in your stomach, which could block your intestines

• Damage to nearby organs

The type of surgery you will require depends on your diagnosis and other factors. Your doctor will be able to help you out with what’s best for your specific situation.

Types of doctors and specialists involved in colon cancer surgery treatment

Both general surgeons and specialists perform colorectal surgery. There are also specialists who have additional experience and training in colorectal surgery.

Surgical oncologists, for example, are doctors who specialize in surgical treatment for cancer. Meanwhile, colorectal surgeons (once called proctologists) are doctors who have had additional training in treating diseases of the colon, anus, and rectum.

What is the survival rate for colon cancer after surgery?

Colon cancer staging helps predict the probability of the recurrence of cancer after surgical removal. Staging helps doctors determine if chemotherapy might be useful in reducing the chances of cancer recurrence.

Five-year survival rates for colon cancer are about 75% with stage I cancers compared to around 5% for stage IV cancers.

What to expect after colon cancer surgery

There is typically a short hospital stay, around two to four days, after colon cancer surgery. During hospitalization, your surgical care team will use Enhanced Recovery After Surgery (ERAS) protocols to promote quicker recovery and decrease your risk of complications like blood clots in your legs or pneumonia.

ERAS protocols include:

• Avoiding narcotic pain management medications

• Encouraging mobility immediately after you are able to get out of bed

• Providing optimal nutrition as soon as you can eat

Some individuals might require a colostomy or ileostomy (temporary or permanent) after surgery. This will take certain lifestyle adjustments and a bit of time to get used to and manage.

The lowdown

A diagnosis of colon cancer does not automatically translate to a death sentence. However, it is a hard diagnosis to receive, and you will need all the support you can get from everyone around you. Have honest and open conversations with your doctor and loved ones to explore your options and express your feelings.