Rectal Cancer Surgery

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Surgeon Emmanuel Pappou

MSK surgeons, such as Emmanouil Pappou, have special expertise in rectal cancer surgery. These procedures are particularly challenging because the rectum is surrounded by the bones of the pelvis.

Questions to Ask Before Rectal Cancer Surgery
7 Questions to Ask Before Rectal Cancer Surgery
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At Memorial Sloan Kettering, surgery is the most common treatment for many stages of rectal cancer. If you or someone you care about has been diagnosed with rectal cancer, we want to help you understand the surgical options so that you have the best outcome possible. This information can help prepare you for the decisions you and your doctors will make together.  

As with many kinds of cancer, early detection is critical. Surgery alone can often be the only necessary treatment for small tumors that haven’t spread through the rectal wall. Sometimes a tumor can be removed though the anus without removing the entire rectum. Other people will need to have most or all of the rectum removed. Cancer that has spread through the wall of the rectum or to nearby lymph nodes usually requires chemotherapy and radiation in addition to surgery.

Surgery for rectal cancer does have some challenges. For example, the pelvis contains many narrow parts, making the area difficult to operate on. This region also contains the nerves that control your ability to use the bathroom as well as those that affect your sexual health. Your MSK surgeon will take every precaution to protect those nerves. Some rectal cancer is likely to come back after surgery.

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Use our online nomogram to calculate risk of cancer recurrence following surgery for colon cancer, and to learn about overall colon cancer survival rates at five years. Results can help physicians and patients make important treatment decisions.
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How do surgery, chemotherapy, and radiation therapy work together to treat rectal cancer?

Because it’s more challenging to operate within the pelvis, chemotherapy and radiation therapy may be used to shrink rectal tumors before surgery, especially larger tumors. This approach is called neoadjuvant therapy. If you’re a candidate for this therapy, your care team will work with you to determine which combination is right for you.

At MSK, neoadjuvant therapy is the standard recommendation for advanced rectal cancer that hasn’t spread or a tumor close to the anus. If you have advanced cancer that has spread to the lymph nodes, a combination of chemotherapy and radiation therapy before surgery can kill microscopic cancer cell growths before they get bigger. This can reduce the risk of the cancer coming back.

Neoadjuvant therapy followed by surgery and chemotherapy gives people with rectal cancer that hasn’t spread an overall cure rate of more than 70 percent. Rectal cancer comes back in less than 10 percent of people who have this sequence of treatment.

Here are some questions you might like to ask your surgeon.

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Will I need a colostomy bag after rectal cancer surgery?

MSK surgeons are constantly developing new, more effective techniques to protect the ability to use the bathroom normally in people who’ve had rectal cancer surgery.

For example, in the past, many people needed a permanent colostomy. This is a surgical procedure that removes the rectum and brings one end of the large intestine out through the abdominal wall. People who have a permanent colostomy are fitted with an ostomy pouching system. This is commonly called a colostomy bag. The bag collects waste from the intestine. People with a permanent colostomy use a bag to collect waste for the rest of their lives.

At MSK, the overwhelming majority of people with rectal cancer can now avoid a permanent colostomy, thanks to advances in surgical techniques. Some people do need a temporary ostomy. After a short period for healing, a surgeon can reconnect the bowel so normal bathroom habits can be resumed.

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How does MSK help quality of life after surgery for rectal cancer?

Our colorectal surgeons use advanced surgical procedures, including:

  • minimally invasive techniques, such as laparoscopy and robotic surgery. With these methods, surgeons can use smaller incisions (cuts) than traditional surgeries.
  • nerve-preserving techniques, which focus on protecting your ability to use the bathroom normally as well as your sexual health (part of the standard of care at MSK).
  • coloanal reconstruction, a procedure in which a surgeon removes the rectum and connects the upper colon directly to the anus. This option works well for people who aren’t good candidates for other techniques, such as men with large prostate glands.
  • colonic reservoir, in which a surgeon loops two sections of the lower colon together and opens up the wall between them to construct an internal colon pouch. This is called a J-pouch. It creates a reservoir for storing waste and improves your ability to go to the bathroom normally after surgery to remove the rectum.
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What is minimally invasive surgery for rectal cancer?

In minimally invasive surgery, doctors can use smaller incisions (cuts) than traditional surgery. These techniques can help minimize damage to nearby organs and tissues. People who have minimally invasive surgery have a lower risk of infection and less blood loss. They often recover faster. At MSK, we use the following minimally invasive methods:

  • Laparoscopy. During a laproscopy, a surgeon uses a thin, lighted tube with a video camera at its tip. This tool is called a laparoscope. It is inserted through a small opening made in the abdominal wall so that the surgeon can operate using special instruments. MSK’s surgeons are helping lead national clinical trials to test this approach in rectal surgery. Early studies show that laparoscopy is safe and feasible. Currently, surgeons usually must make an incision low in the pelvis to complete the surgery.
  • Robotic-assisted surgery. This type of surgery began around 2002. Doctors at MSK helped pioneer its use for colon and rectal surgery. Special instruments are inserted through keyhole-size cuts in the abdominal wall. The surgeon sits at a computer and uses controls to move robotic arms that precisely operate the surgical tools. A high-definition visual system helps the surgeon see more clearly by magnifying the operation.

    MSK’s surgeons perform more robot-assisted minimally invasive procedures for colon and rectal cancer than doctors at any other institution in the country. You and your doctor will decide together if it’s the best option for your treatment.

  • Transanal endoscopic microsurgery (TEM). This procedure involves removing early-stage rectal cancer using a scope that’s inserted into the anus. TEM typically takes less time than standard abdominal surgery. It is ideal for older patients with medical conditions that would make longer and more complex operations difficult, or for people who don’t want a standard operation. TEM minimizes treatment-related complications, reduces recovery time, and spares the nearby nerves associated with the ability to use the bathroom normally as well as with sexual health. Most importantly, people who have TEM don’t need a colostomy. They can go home soon after the procedure. Our experienced rectal surgeons have been performing TEM since 2004.
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Why should I choose MSK for rectal cancer surgery?

Research shows that surgeons at centers where a high number of procedures are performed produce the best results for their patients. MSK’s surgeons are among the most experienced in the world at removing rectal cancer.

MSK is recognized around the world as a leader in treating rectal cancer. Each year we care for more than 1,200 people with colon and rectal cancer, restoring people to health after every kind of rectal cancer, including the rarest types. We will tailor a treatment specifically for you.

Many of the most-advanced techniques developed recently were first studied and used by MSK’s colorectal cancer team. The people we care for have access to clinical trials with new treatment options that may not be available at other hospitals.

We believe you should choose MSK because we offer:

  • Compassionate care from a team of more than 70 colorectal cancer care specialists, nurses, and other health professionals. Our surgeons work with experts from diverse fields, including chemotherapy, radiology, pathology, and symptom management. Many of them are nationally or internationally recognized.
  • The most-advanced rectal cancer treatments, including minimally invasive surgeries, which use smaller incisions (cuts) than traditional surgery. Our high level of expertise reduces recovery time and leads to fewer complications. We are also leaders in treating rectal cancer without surgery when possible.
  • A commitment to your quality of life. Our specialists take every measure to preserve your ability to use the bathroom normally as well as your sexual health. We can help you not just survive but thrive.
  • The first clinic in the world for people under 50 with colorectal cancer. The Center for Young Onset Colorectal Cancer was created to address a troubling rise in this disease among people as young as their 20s and 30s. The specialists at the center help younger patients with the specific challenges they face while advancing research into the causes of this disturbing new trend.
  • Personalized screening and monitoring after treatment. This includes our Hereditary Colorectal Cancer Family Registry for families who are affected by genetic colorectal cancer syndromes and may be at an elevated risk.
  • A dedication to giving you the best outcome possible and ensuring that you are happy with your care. We track patient satisfaction and use your feedback to continually improve.
  • Flexibility in how and where to receive treatment. Our specialists are conveniently located in Manhattan and at our regional outpatient locations in New Jersey, on Long Island, and in Westchester County. This provides our patients with the same outstanding care from MSK doctors closer to home.
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What kind of support will I get after rectal cancer surgery at MSK?

Our specialists provide comprehensive follow-up care to help you live well after rectal cancer treatment. Our service includes:

  • a team of experts to oversee all aspects of your recovery, including rectal cancer specialists, psychologists, and social workers
  • care from a nurse practitioner who specializes in colorectal cancer survivorship and will monitor your health and help you if you have any long-term effects
  • a personalized survivorship care plan with the medical guidance you’ll need to transition to a healthy life after rectal cancer treatment
  • wellness therapies from integrative medicine specialists, if you need help relieving emotional or physical symptoms after treatment
  • rehabilitation and exercise therapies to help you heal and recover your strength, flexibility, and stamina
  • emotional support at our Counseling Center
  • a patient-to-patient support program, which connects you with other rectal cancer survivors who understand your challenges and concerns
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