Colorectal Cancer Surgery: principles and types

The main principles of colorectal cancer surgery and the most common options for surgery based on anatomical location of the cancer.

The majority of colorectal cancer surgeries are performed with curative intent. They aim to remove the tumour, with margins free from disease, as well as local tissues including lymph nodes. Consideration is also made to how bowel function can be preserved as close to normal post surgery.

Surgery may be used before or after chemo or radiotherapy.

Many operations are now laparoscopic (keyhole) but occasionally an open operation is required.

The aim in the majority of cases is to join the ends of bowel after the excision in what is called a primary anastomosis. Occasionally a defunctioning loop stoma is required to allow the join to heal.

Operations include - right hemicolectomy, left hemicolectomy, sigmoidectomy, high and low anterior resections, and abdominal perineal excision of the rectum and anus (APER). The choice depends on where the tumour is. The majority are performed with a primary anastomosis, with the exception of APER where the rectum is completely removed, meaning an end colostomy is required (a permanent stoma).

Other surgeries include transanal endoscopic microsurgery (TEMS) for superficial rectal tumours, and total/subtotal colectomy for polyposis.

For a basic overview of colorectal cancers please have a look at our last video:    • Colorectal Cancer: An overview