Laparoscopic colon cancer surgery: the operation, the lymph nodes and your recovery

In a partial colectomy, also called a hemicolectomy or segmental resection, the surgeon removes the section of colon holding the cancer with a margin of healthy bowel on each side. Usually about a quarter to a third of the colon is taken, depending on the tumour's size and position (American Cancer Society). The two healthy ends are then joined again, a connection called an anastomosis (NCI).

Types of colectomy

The operation is named after the part removed: a right hemicolectomy for the right side, a left hemicolectomy for the left side and a sigmoid colectomy for the sigmoid colon (Cancer Research UK). Removing the whole colon is rarely needed for colon cancer; it is used mainly for other conditions such as familial adenomatous polyposis (ACS).

The bowel is removed together with the fatty tissue that carries its blood vessels and lymph nodes. The American Cancer Society says at least 12 nearby lymph nodes are removed so they can be checked for cancer (ACS). How many nodes contain cancer is part of the final stage (NCI).

This shapes what happens next. When the nodes contain cancer (stage III), surgery is usually followed by chemotherapy, called adjuvant therapy, to lower the chance of the cancer coming back (NCI). That decision belongs to the medical oncologist, working from the pathology report.

Surgery is the main treatment for colon cancer that can be removed, and the keyhole approach gives similar cancer results to open surgery when the surgeon has the right training (ACS). Some very early cancers inside a polyp can be removed during a colonoscopy without an operation (NCI).

Keyhole surgery is not possible for everyone, and the surgeon may need to convert to open surgery during the operation when that is safer (Cancer Research UK). Scans, tumour position, previous abdominal operations and your general health all shape the choice, made with you after the team meeting.

1. You are asleep under a general anaesthetic.
2. The surgeon makes several small cuts and passes a camera and fine instruments through them (Cancer Research UK).
3. The diseased segment is freed along with its blood vessels and lymph nodes, then taken out through one slightly larger cut.
4. The healthy ends are joined (anastomosis), or, if joining is not safe, a stoma is made (NCI).
5. The specimen goes to the pathologist, whose report gives the final stage.

The same oncological principles guide other abdominal cancer operations, such as stomach cancer surgery.

Staging comes first: a CT scan of the chest, abdomen and pelvis and a CEA blood test help show whether the cancer has spread, and colonoscopy with biopsy confirms the diagnosis (NCI). Fitness checks may include blood tests, an ECG, lung function tests, an echocardiogram and a chest X-ray, usually at a pre-assessment visit one or two weeks before the operation (Cancer Research UK).

If you smoke, stopping at least a few weeks before surgery helps, as do staying active, eating well and cutting down on alcohol (Cancer Research UK). Many units also give carbohydrate drinks the day before and the morning of surgery, plus bowel preparation where needed (NHS Worcestershire).

Enhanced recovery after surgery (ERAS) is an evidence-based package of care before, during and after the operation, set out for colorectal surgery by the ERAS Society (ERAS Society). In practice it means eating, drinking and walking early, with good pain control. You may be sitting in a chair within 12 hours of the operation (Cancer Research UK).

You go home once you are eating and drinking, walking, passing wind, comfortable on tablets and free of fever; the stay usually ranges from 3 to 7 days (NHS Worcestershire). Many people return to desk work after about 4 weeks, while heavy lifting and manual work wait at least 6 weeks. Tiredness can last several weeks, sometimes months (Cancer Research UK).

Most colon cancer operations rejoin the bowel without a stoma. A colostomy may be needed when a blocked colon cannot be safely reconnected or the tumour has made a hole in the bowel; it is usually temporary and is often reversed about 2 to 6 months later (ACS).

A temporary stoma gives the join time to heal, and surgeons avoid a long-term stoma whenever possible (Cancer Research UK). If a stoma is likely, a stoma nurse meets you before surgery, marks a suitable site and teaches you to care for it afterwards.

Early problems can include bleeding, wound, chest or urine infection, and blood clots in the legs that can travel to the lungs (Cancer Research UK). The bowel may be slow to wake up (ileus), which usually settles with fluids through a drip and a tube to rest the stomach (Cancer Research UK).

The most serious complication is an anastomotic leak from the join. It is rare, but it needs treatment straight away and may mean another operation and sometimes a stoma (Cancer Research UK). Scar tissue (adhesions) and looser or more frequent stools can also follow (ACS).

Call the surgical team the same day if you notice any of these after going home (NHS Worcestershire, Cancer Research UK):

• Abdominal pain that is getting worse, or a hard, swollen belly with fever (ACS)
• Vomiting that does not stop or prevents normal eating
• A high temperature or shivering
• Redness, swelling or discharge from a wound
• A swollen, hot, red or painful leg

Shortness of breath, chest pain or coughing up blood can mean a clot in the lung: go to the nearest emergency department at once.

Long-term results depend mainly on the stage, confirmed by the pathology report after surgery. In the COST trial of 872 patients, laparoscopic and open colectomy gave similar cancer recurrence and survival, and the keyhole group left hospital sooner (median 5 vs 6 days) and needed less pain medicine (NEJM 2004).

Follow-up with scans and blood tests continues after recovery, so that any return of the cancer is found early. Our page on breast cancer surgery explains how the same team approach works for a different organ.

Sources: NEJM 2004, NCI, ACS. The right option is chosen after staging and the team discussion.

The price of colon cancer surgery depends on the hospital and room class, the surgical technique and the staplers and keyhole instruments it needs, and how long you stay, including any time in high dependency care. Staging scans, pathology and follow-up add to the total; chemotherapy is priced separately.

A written quote should list what is included and what is not. To get a current one and discuss your reports, book a consultation with Dr. Yasser, and ask the clinic about payment options.