Colorectal Cancer: Surgery

Pictured: Philip Paty Memorial Sloan Kettering's Philip Paty, a surgical oncologist, specializes in minimally invasive laparoscopic surgery for colorectal tumors.

Surgery is the most common treatment for colon cancer. When the cancer is found early, surgical removal of the tumor can lead to a cure.

Memorial Sloan Kettering’s surgeons treat a large number of people with colon cancer and as a result have developed an extraordinary degree of expertise. This expertise translates into highly successful procedures that minimize disruptions to a normal lifestyle. Research studies have shown that cancer centers and surgeons that perform a higher volume of colon cancer surgeries produce better outcomes for patients, including fewer postoperative complications.1,2

At Memorial Sloan Kettering, our surgeons place a priority on not only treating the disease but on preserving a high quality of life for the patient following an operation. We are continually developing and refining new techniques to preserve normal function following colon surgery.

Types of Surgery for Colon Cancer

When colon cancer is at an early stage, the tumor is often fully contained within a polyp. In these cases, removing the polyp during a colonoscopy may be enough to cure the cancer.

If your colon cancer is more advanced and has begun to spread through the colon, more extensive surgery is needed. In a procedure called a hemi-colectomy, the surgeon removes several inches of the bowel, including the segment of the colon that contains the tumor. The surgeon also removes nearby lymph nodes to which the tumor might have spread.

In most cases, the surgeon can then reconstruct the bowel by joining the two ends of the remaining bowel. Fortunately, the body tolerates hemi-colectomy quite well, and bowel function usually returns to normal in just a few months.

Bowel surgery at Memorial Sloan Kettering can be performed either through an open procedure or, in many cases, using minimally invasive techniques

Minimally Invasive Surgery for Colon Cancer

Minimally invasive surgery is a surgical procedure performed through small incisions — usually made in the abdominal wall — which results in the least possible harm to organs and surrounding tissue. Minimally invasive surgery typically has a number of potential benefits for patients, including fewer complications, less blood loss, a shorter hospital stay, and quicker recovery than conventional open surgery.

There are two types of minimally invasive surgery for colon cancer: laparoscopic surgery and robotic surgery.

Laparoscopic Surgery for Colon Cancer

Surgeons at Memorial Sloan Kettering now perform a significant portion of colon surgeries laparoscopically. Laparoscopic surgery is a type of minimally invasive surgery in which a thin, lighted tube with a camera at its tip (called a laparoscope) is inserted through a small incision in the abdomen. The camera projects a magnified, high-definition image of the surgical area onto a screen. Using the image as a guide, the surgeon uses specialized surgical instruments to perform the surgery.

Studies have shown that patient outcomes (in terms of overall survival and risk of cancer recurrence) are similar when comparing laparoscopic colon cancer surgery with conventional open surgery.3

Robotic Surgery for Colon Cancer

Specially trained surgeons at Memorial Sloan Kettering have begun investigating the use of an advanced robotic device — called the daVinci® Surgical System — to remove colon cancer. During robotic surgery, the surgeon sits at a console that has hand, finger, and foot controls. The robot precisely copies every movement while the surgeon views the operation on a screen.

The robotic arms have multiple joints and can maneuver in small spaces with great dexterity. The robot also increases the precision of the surgeon's motions by scaling down each movement by half or even three quarters. This allows the surgeon to make much finer movements in tight spaces than would be possible in open or traditional laparoscopic surgery. The finer movements help the surgeon to avoid damaging nerves and to maintain the patient’s normal function to the greatest possible extent.

Robotic devices have been used successfully to treat other types of cancer — such as prostate cancer and gynecological cancers — but their use to treat colon cancer is still in an early stage and is appropriate only in specific conditions.

Surgery and Advanced Colon Cancer

If you have colon cancer that has metastasized (spread) to other organs, it may not be in your best interest to have a tumor removed from the colon by surgery. A 2009 study by Memorial Sloan Kettering researchers showed that a large majority of patients with advanced colon cancer that has spread to other organs don't require immediate surgery to remove the primary tumor in the colon.4

As long as the tumor is not causing obstruction, perforation, or bleeding, you may be best treated with chemotherapy. By moving straight to chemotherapy, you may also be able to avoid the risk of surgical complications and start treatment for the disease throughout the entire body without delay.

1Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection. Schrag D, Panageas KS, Riedel E, Hsieh L, Bach PB, Guillem JG, Begg CB. J Surg Oncol. 2003 Jun;83(2):68-78; discussion 78-9. [PubMed Abstract]

2The importance of volume in colorectal cancer surgery. Hermanek P, Hohenberger W. Eur J Surg Oncol. 1996 Jun;22(3):213-215. [PubMed Abstract]

3Five-year long-term outcomes of laparoscopic surgery for colon cancer. Bai, HL, Chen B, Zhou Y, Wu XT. World J Gastroenterol. 2010 Oct 21;16(39):4992-7. [PubMed Abstract]

4Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. Poultsides GA, Servais EL, Saltz LB, Patil S, Kemeny NE, Guillem JG, Weiser M, Temple LK, Wong WD, Paty PB., Guillem JG, Weiser M, Temple LK, Wong WD, Paty PB. J Clin Oncol. 2009 Jul 10;27(20):3379-84. Epub 2009 Jun 1. [PubMed Abstract]