Sphincter Sparing Procedures for the treatment of Rectal Cancer
If you have been diagnosed with rectal cancer, there are essentially three operations that can be offered to cure the cancer. Two of the three operations allow a patient to have a successful surgical treatment of the cancer along with sparing the anal sphincter so as to avoid a permanent colostomy. The most common operation we offer patients is called a "low anterior resection". This involves removing all or part of the rectum and taking healthy bowel from the colon and then "anastomosing" (hooking up) it to the remaining rectum. Occasionally, if the hookup is very close to the anus (or anal sphincter), it is then recommended that the patient have a temporary, proximal, diverting ileostomy, or bag. This temporary bag allows the complicated surgery that has been performed to heal without stool passing across the new hookup. After a period of approximately two to three months, the temporary colostomy or ileostomy can be taken away with a second surgery and then the patient will be able to evacuate in the normal fashion.
| | Rectosigmoid Resection
For most rectal cancers, a segment of the colon is removed and then normal colon from above the removed segment is attached, often with a special stapling instrument, to the remaining rectum. Click for larger image |
One aspect of any type of rectal surgery is that there is usually a change in bowel habits. Patients experience more frequent bowel habits after the surgery and occasionally patients do complain of problems with incomplete evacuation. Many of these problems resolve over several months. During this period of adjustment, your progress will be followed by our office and you will be given advice on proper diet and maneuvers that will help to maximize normal bowel function.
Another procedure that can be offered to patients with small rectal cancers that are very close to the anal area is a "local excision". This procedure is performed through the anus or through the tailbone area to remove the small cancer without a colostomy. Sometimes this procedure can be done on an outpatient basis. Depending on the extent of the small cancer, adjuvant, or extra, therapy with radiation and chemotherapy is sometimes recommended. The advantage of this procedure is that it is relatively minor and preserves the muscles of the anus so that a patient does not require a permanent colostomy. However, patients who do have a local excision need to be followed very closely to insure that there is no recurrence. We also offer a protocol for the treatment of patients with small, distal rectal cancers in conjunction with our colleagues at the Dana-Farber Cancer Institute.
 | | Local excision of a small distal rectal cancer
The tumor is removed through an anal approach. A full-thickness "disc" is removed from the rectal wall and a small defect is sewn closed. Click for larger image |
Abdominal-Perineal Resection
If you have a large cancer, or if it involves the muscles of continence (the anal sphincters), then a sphincter-sparing procedure cannot be performed. In this situation, an abdominoperineal resection (APR) procedure will need to be performed. The advantage of this operation is that it removes all of the cancerous tissue but it does leave you with a permanent colostomy. If you should require this operation, we will have you see one of our Enterostomal Therapists prior to the procedure to discuss and educate you about living with a colostomy. The Enterostomal Therapists also help the surgeon choose the best spot for the colostomy in order to avoid problems with the ostomy appliance on the abdominal wall. This teaching and education continues postoperatively, both in the hospital and at several followup outpatients visits. The quality of life has been shown to be good to excellent in patients with a well-functioning colostomy and, when necessary, allows the surgeon and the other treating physicians to aggressively and successfully treat your rectal cancer.
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