Colorectal surgeon José G. Guillem
At Memorial Sloan Kettering, surgery is the most common treatment for many stages of rectal cancer. As with many kinds of cancer, early detection is critical. Surgery alone can often be the only necessary treatment for early-stage rectal cancer. Our surgeons can often remove small tumors that haven’t spread through the bowel wall; cancers that have spread through the wall or to nearby lymph nodes may require more extensive surgery.
Surgery for rectal cancer does have some challenges. For example, your pelvic bone contains many narrow parts, making the area difficult to operate on. This region contains the nerves that control your sexual and bladder function as well as bowel function, so your surgeon must take every precaution to protect those nerves. Another challenge is recurrence — some rectal cancers are likely to come back after surgery.
Because it’s more challenging to operate within the confines of the pelvis, chemotherapy and radiation therapy may be used to shrink the rectal tumor before surgery, especially in the case of larger tumors. This approach is called neoadjuvant therapy. If you’re a candidate for this therapy, your treatment team will work with you to determine which combination is right for you.
Neoadjuvant therapy is our standard recommendation if you have locally advanced rectal cancer or a low-lying tumor (close to the anus). If your diagnostic tests indicate you have an advanced cancer that has spread to the lymph nodes, chemoradiation before surgery can eliminate microscopic cancer cell growths before they get bigger. This can reduce the risk of the tumor coming back.
At Memorial Sloan Kettering, our surgeons are constantly looking for new, more effective techniques to protect normal body functions for people who’ve had rectal cancer surgery.
For example, in the past, many patients needed a permanent colostomy, a surgical procedure that removed the rectum and brought one end of the large intestine out through the abdominal wall. These patients would spend the rest of their lives fitted with an ostomy pouching system (commonly called a colostomy bag) to collect waste from the intestine. At MSK, the overwhelming majority of our patients can now avoid permanent colostomy thanks to advances in surgical techniques.
Some of the more advanced surgical procedures our rectal surgeons use include:
- minimally invasive techniques such as laparoscopy and robotic surgery
- nerve-preserving techniques, which focus on protecting your sexual and urinary function (part of the standard of care at MSK)
- coloanal reconstruction, a procedure in which your surgeon removes your rectum and connects your upper colon directly to your anus. This option works well for patients who aren’t good candidates for other techniques, such as men with large prostate glands.
- colonic reservoir, in which your surgeon loops two sections of your lower colon upon itself and opens up the wall between them to construct an internal colon pouch called a J-Pouch. This creates a reservoir for storing waste and allows you to improve your bowel function if you have surgery to remove your rectum.
Surgeons at Memorial Sloan Kettering have been leaders in incorporating minimally invasive surgical techniques into rectal cancer operations.
Three techniques in particular — laparoscopy, robotic surgery using the da Vinci® Surgical System, and transanal endoscopic microsurgery (TEM) — can help minimize damage to nearby organs and tissues, lower infection risks and blood loss, and quicken recovery time.
- Laparoscopy involves a thin, lighted tube with a video camera at its tip (a laparoscope) that is inserted through a small incision in the abdominal wall. Your surgeon can operate through this small opening using special instruments. Our surgeons are helping lead national clinical trials to assess this approach in rectal surgery. Early studies indicate laparoscopy is safe and feasible. At this time, surgeons usually must make an incision low in the pelvis to complete the surgery.
- The da Vinci® Surgical System is a state-of-the-art robotic surgical tool that helps your surgeon provide quality treatment and may decrease postsurgery pain and recovery time. Robotic devices have been used successfully to treat other types of cancer, such as prostate and gynecological tumors. Using the da Vinci® Surgical System to treat rectal cancer is still relatively new — it’s appropriate only in specific conditions.
- Transanal endoscopic microsurgery (TEM) is a procedure that involves removing early-stage rectal cancers using a scope that’s inserted into the anus under either general or spinal anesthesia. It typically takes less time than standard abdominal surgery and is ideal for older patients with medical conditions that would make more-intense operations difficult, or for those who don’t want to undergo a standard operation. TEM also minimizes treatment-related complications, reduces recovery time, and spares nearby nerves associated with urinary control and sexual function. Most importantly, TEM patients don’t require a colostomy. TEM patients can go home soon after the procedure; standard abdominal procedures require up to a week of recovery at MSK. Our experienced rectal surgeons have been performing TEM since 2004.