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Surgery for Rectal Cancer: Stages II, III, IV

A Transanal Resection (also known as "Colectomy" or "Partial Colectomy")

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A transanal resection is the removal of small tumors in the lower rectum near the anal opening which have not invaded the layers of the colon and which can be removed with a safety margin of healthy tissue around the tumors.

  • When performed without a scope, the procedure is known as transanal excision (TAE). 
  • When performed with a scope, the procedure is known as transanal endoscopic microsurgery (TAEM). 
  • Both procedures leave the anus and sphincter intact. This allows patients to keep bowel function and eliminates the need for a permanent colostomy.
  • A transanal resection is performed by a colorectal surgeon.  

Types of Colectomies: 

Low anterior resection: This approach is used for cancers near the upper part of the rectum, close to where it connects with the colon. The surgeon makes the cut in the belly. Then he or she removes the cancer and a small amount of normal tissue on either side of the cancer, along with nearby lymph nodes and a large amount of fatty and fibrous tissue around the rectum. The anus is not affected. After the surgery, the colon is reattached to the anus and waste leaves the body in the usual way. 

Proctectomy with colo-anal anastomosis: For some stage I and most stage II and III rectal cancers in the middle and lower third of the rectum, the entire rectum and the colon attached to the anus will need to be removed. This is called a colo-anal anastomosis (anastomosis means "connection"). This is a harder operation to do. For a short time, an ostomy (an opening on the belly for getting rid of body wastes) is needed to allow healing after surgery. A second operation is done later to close the ostomy opening.     

Abdominoperineal (AP) resection: For cancers in the lower part of the rectum, close to its outer connection to the anus, an abdominoperineal (AP) resection is done. For this procedure, the surgeon makes a cut in the belly (abdomen), and another in the area around the anus. Because the anus is removed, a colostomy is needed. A colostomy is an opening of the colon in the front of the abdomen. It is used as a way for the body to get rid of solid body waste (feces or stool). The usual hospital stay for an AP resection is 4 to 7 days, depending on your overall health. 

Pelvic exenteration: If the rectal cancer is growing into nearby organs, more extensive surgery is needed. In a pelvic exenteration the surgeon removes the rectum as well as nearby organs such as the bladder, prostate, or uterus if the cancer has spread to these organs. A colostomy is needed after this operation. If the bladder is removed, a urostomy (an opening to collect urine) is also needed.


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