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Surgery For Colon Cancer: Stages II, III, IV

Resection: Open Surgery vs. Laproscopy (Laproscopic surgery)

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Traditionally, the incision for a colorectal cancer operation is fairly large. This is known as “Open Surgery.” More recently, surgeons have been able to perform minimally invasive surgery by making small incisions through Laparoscopic or Robotic Surgery. 

The method of getting through the skin does not change the effectiveness of the treatment or change in the rate of long term survival. Neither does traditional surgery compared to robotic surgery. However, healing is usually faster with laparoscopic or robotic surgery because there is not a large incision in the skin. Also, doctors have noticed that patients with smaller entries have less scar tissue so we may start seeing less problems with bowel obstruction due to scar tissue and may start seeing lower incidence of hernia formation in patients with laparoscopies or robotic surgery. However, at the moment, that is just a "best guess."

A determination whether a patient is a candidate for a minimally invasive surgery instead of open surgery depends on several factors:

  • The skill and training of the surgeon.
  • The disease progression.
  • The patient's body weight. A patient who is morbidly obese (a BMI of more than 40) has a less likelihood of successfully being treated with a minimally invasive approach.
  • Patients with severe inflammatory bowel disease or severe diverticulitis may or may not be able to be treated with laparoscopy. 
Once inside, surgeons do the same work with either procedure. They remove the tumor and a short piece of healthy bowel on either side. The ends are then reconnected. Nearby organs such as the liver and lungs are checked to see if the cancer has spread. For information about the practical aspects of a resection operation, starting with preparation before the operation, see the other sections of this document. 

Open resection surgery
  • The surgeon makes a large cut into your abdomen.
  • The surgeon removes the tumor and part of the healthy colon. Nearby lymph nodes will also be removed. The surgeon checks the rest of your intestines, liver and possibly other organs to see if the cancer has spread.
  • Open surgery generally takes 1 – 4 hours .
  • The stay in the hospital is usually 4 – 7 days.

Laproscopic resection surgery

Laparoscopy is minimally invasive surgery which can accomplish the same result as more invasive traditional surgery by using a thin, lighted tube known as a laparascope. Any segment of the colon may be removed with a laparoscopy. Studies show that even obese patients and patients who have had prior surgery can have this surgery. 

  •  With a laparascopy, the incision is 2 inches or 3 or 4 tiny cuts of a quarter to one half inch in the abdomen instead of an 8-12 inch incision. (One of the incisions is used to inject carbon dioxide into the abdomen. The carbon dioxide separates the abdominal wall so the surgeon can operate). Sometimes only one small opening (port) is involved. (This is known as the No Visible Scar or Single Port Approach). The No Visible Scar approach moves the single cut to the area below the pubic hair line.
  • The surgeon sees inside your body on a video monitor by manipulating the laparoscope. He or she does the same procedure as in open surgery. 
  • Colon surgery using laparoscopy generally takes 2 – 4 hours .
  • The risks and complications are generally about the same as for open surgery. Complications are significantly higher for surgeons who do not have adequate training or do not do a large number of these procedures.
  • Most institutions doing the open surgery also use the laparoscopic technique.

Laparoscopic operations were first performed in 1991.

There are both short term and long term benefits to laparoscopy compared to traditional surgery.

  • In the short term:
    • Recovery is faster and easier because of the smaller incision:
    • There is less pain.
    • Less pain medicine is needed.
    • People can take deep breaths easier and get out bed and walk a lot sooner.
    • Less time is required for bowel function to recover.
    • People tend to do better in the hospital. For example, people can be fed pretty much right away, with something to drink and to advance the diet. People can generally leave the hospital within 3 – 5 days after the operation. 
    • Less blood loss.
    • Better quality of life.
  • In the longer term: Recovery at home is usually about 2 weeks compared to 6 to 8 weeks of recovery needed after a regular operation.

Most health insurance policies cover laparascopic surgery. At the least, policies pay the same as for an open operation. (How much a policy pays is generally a problem for the surgeon’s staff rather than for the patient).

For information about how to stay safe in a hospital and to maximize your stay, see the documents in "To Learn More" below.


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