Colorectal Cancer Surgery

Introduction

Surgery for colorectal cancer is the main treatment for the majority of patients with colon or rectal cancer. It entails the removal of the tumor and a section of the colon, rectum, and nearby lymph nodes. Depending on the stage and location of the cancer, various surgical methods are used, from minimally invasive laparoscopic surgery to extensive open surgery. This manual delves into the colorectal cancer surgery landscape, indications, procedure types, recovery time, expenses, and clinical trials in China.

About the Disease

Colorectal cancer describes cancers that arise in the colon or rectum, components of the large intestine. It initially starts off as minute, benign polyps that have a potential to become cancerous over time. Lifestyle habits, family history, age, and inflammatory bowel disease raise the risk. Early diagnosis facilitates curative surgery, so surgery is a pillar of colorectal cancer treatment.

Indications

Surgery is typically the first-line treatment for localized colorectal cancer. The aim is to remove the tumor and prevent recurrence. We recommend surgical intervention in the following scenarios:

• Early-stage colon or rectal cancer (Stage I-III)

• Obstructive tumors causing bowel blockage

• Bleeding tumors

• Metastatic disease with operable liver or lung metastases

• As a palliative measure to relieve symptoms

Treatment Details

Surgical treatment depends on the tumor’s size, location, and stage. Pre-operative tests such as colonoscopy, MRI, CT scans, and biopsy help define the surgical plan.

Types of Surgeries:

Colon Cancer Surgeries:

• Polypectomy/Local excision: Removal of small cancerous polyps during colonoscopy.

• Partial colectomy (hemicolectomy): Removal of the cancerous part of the colon and adjoining lymph nodes.

• Total colectomy: Entire colon is removed (less common).

Rectal Cancer Surgeries:

• Low anterior resection (LAR): Removes the affected rectum while preserving the anal sphincter.

• Abdominoperineal resection (APR): Removes rectum and anus, leading to a permanent colostomy.

• Transanal excision (TAE): For small early-stage tumors close to the anus.

Surgical Approaches:

• Open surgery: Traditional, with a single large abdominal incision.

• Laparoscopic surgery: Minimally invasive, involves small incisions and quicker recovery.

• Robotic-assisted surgery: Offers better precision and visualization.

Medicines Used

Although surgery doesn’t involve medications as a core component, perioperative care requires certain drugs to manage recovery and reduce complications.

Common Medications:

• Antibiotics – Prevent post-operative infections.

• Analgesics – Manage pain after surgery.

• Anticoagulants – Prevent blood clots.

• Stool softeners and laxatives – Help regulate bowel movements.

• Chemotherapy drugs (post-surgery) – For stage III or high-risk stage II cases, usually 5-FU, Capecitabine, or Oxaliplatin.

Effectiveness

Surgery is the most effective curative treatment for early- to mid-stage colorectal cancer.

Success Rates:

• Stage I–II: Surgery alone often leads to high cure rates (>80% 5-year survival).

• Stage III: Surgery combined with chemotherapy improves survival significantly.

• Metastatic disease: Surgery of both the primary tumor and metastases can offer long-term control or cure in select patients.

Surgical margins, lymph node removal, and thoroughness of excision determine long-term outcomes.

Risks and Side Effects

While surgical techniques have improved, there are still risks involved, especially in older patients or those with comorbidities.

Short-term Risks:

• Bleeding

• Infection

• Blood clots

• Bowel obstruction

• Anastomotic leakage (leak from reconnected bowel)

Long-term Side Effects:

• Bowel habit changes (constipation or diarrhea)

• Urinary or sexual dysfunction (especially in rectal surgeries)

• Stoma-related issues in case of colostomy/ileostomy

• Scar tissue or hernia formation

Experienced surgical teams and postoperative care can minimize complications.

Recovery and Aftercare

Recovery after colorectal cancer surgery varies from a few weeks to months, depending on the procedure and the patient’s condition.

Hospital Stay:

• Laparoscopic surgery: 3–5 days

• Open surgery: 5–7 days

• APR or total colectomy: Up to 10 days

Recovery Plan:

• Start with a liquid diet, then gradually resume solids

• Pain management through IV or oral analgesics

• Walking and breathing exercises to prevent clots and pneumonia

• Wound care and stoma care education

• Bowel training and psychological counseling for patients with stoma

Follow-up includes periodic blood tests, colonoscopy, and CT scans every 3–6 months for 3–5 years post-surgery.

Cost and Availability

The cost of colorectal cancer surgery varies greatly depending on the country, hospital, type of surgery, and whether it’s combined with chemotherapy or radiotherapy.

Availability in India:

India offers a full range of colorectal surgical options in reputed hospitals like Tata Memorial Hospital, AIIMS, Apollo Hospitals, and Fortis. Laparoscopic and robotic-assisted surgeries are widely available at a lower cost compared to Western countries.

Availability in China:

China has made significant advancements in surgical oncology. Leading institutions like Fudan University Cancer Hospital and Beijing Cancer Hospital offer minimally invasive and robotic colorectal surgeries. Access to surgery is widely available in both public and private hospitals.

Patient Experiences

Many patients undergoing colorectal cancer surgery share hopeful stories, especially those diagnosed early. Despite fear of surgery or colostomy, most patients adapt and regain quality of life within months.

Common Themes:

• Relief after tumor removal

• Challenges with bowel habits post-surgery

• Adjusting to life with or without stoma

• Importance of early detection

• Support from healthcare providers and family

Patient testimonials often highlight the resilience built during recovery and the role of support systems in coping with physical and emotional impacts.

Cost in Countries Like China, India, Israel, Malaysia, Korea, Thailand, Turkey, and USA

Note: Additional costs may include diagnostics, stoma bags, ICU care, or adjuvant therapy.

List of Ongoing Clinical Trials in China

China is actively conducting clinical research to improve surgical outcomes for colorectal cancer.

Key Clinical Trials (as of 2025):

• NCT05891200: Evaluating robotic-assisted colorectal cancer surgery vs conventional laparoscopy.

• NCT05848679: Comparing outcomes of total mesorectal excision vs partial mesorectal excision.

• NCT05829311: Neoadjuvant chemotherapy + immunotherapy followed by surgery.

• NCT05791234: Enhanced recovery after surgery (ERAS) protocol effectiveness.

• NCT05877022: Surgical resection of liver metastases following chemotherapy.

Patients can consult major oncology hospitals in Beijing, Guangzhou, and Shanghai to inquire about enrollment opportunities.

FAQ

Is surgery always required for colorectal cancer?
In the majority of early- to mid-stage cases, the answer is yes. However, non-surgical treatments may be considered in inoperable or very early-stage tumors.

Will I need a colostomy bag?
Not always. Many surgeries, such as those for colon cancer, do not require it. It depends on tumor location.

How long is recovery after surgery?
Typically 4–6 weeks for laparoscopic surgery, longer for open procedures or those with complications.

Is robotic surgery better?
Robotic surgery offers greater precision, especially in narrow pelvic spaces (rectal cancer), but isn’t always necessary.

Can colorectal cancer return after surgery?
Yes. That’s why follow-up with colonoscopy and scans is crucial for early detection of recurrence.

What diet should I follow after surgery?
Start with a low-fiber diet, then gradually increase fiber intake. Hydrate well and avoid irritants like caffeine, spicy food, or alcohol initially.

Is surgery painful?
Pain is managed with modern medications and typically reduces within days.

Can I lead a normal life after colorectal cancer surgery?
Yes, most patients return to regular activities within weeks to months with proper care and support.