Colectomy refers to a surgical procedure to remove all or some of a diseased or damaged colon. It is a treatment option for people with colon cancer, and it may also include the removal of nearby lymph nodes.
Colon cancer may begin from polyps in the large intestine or inside the rectum. Screening can lead to the early detection of these polyps, and early detection may lead to a complete cure.
However, if cancer cells grow and spread through a person’s body, they have “metastasized,” and this creates a more serious condition.
In 2021, colon cancer will account for an estimated
This article covers what to expect before, during, and after the procedure. It also looks at risks, complications, and more.
Healthcare professionals tend to treat colon cancer using a type of surgery called colectomy.
If the cancer is not at a very early stage and a surgeon cannot remove it without cutting through the abdominal wall, they may carry out a colectomy procedure.
There are several types of colectomy procedure, including:
- partial or subtotal colectomy
- total colectomy
- total proctocolectomy
In some cases, a surgeon will need to create a permanent or temporary stoma, which contains a portion of the intestine to allow feces and other waste to exit the body.
A colostomy bag is attached to the stoma to collect the fecal material.
A healthcare professional may recommend colectomy for several medical conditions that involve the bowel, including:
Before deciding on the need for a surgical procedure, the healthcare professional will take a person’s medical history and complete a physical examination.
They will also generally carry out a colonoscopy procedure. This involves using a light and camera on a thin tube to inspect the colon. There may also be a manual rectal exam.
Before any surgical procedure, a person will undergo some tests, have some discussions, and receive some advice.
Before surgery, a person will undergo various tests and examinations, which may include:
A surgeon will need to know the person’s entire medical history, including any current illnesses or past serious illnesses. They may also need to discuss symptoms, home remedies, or medications.
A healthcare professional may advise people who smoke to try to quit smoking before their operation to reduce the risk of lung infections after surgery.
The surgeon will explain which pain medications to use after the procedure and how to care for the incision. Their advice will include how to decrease or change any medications that may impact recovery, anesthetic response, or blood clotting.
They may also prescribe antibiotics and other medications to take before surgery to clear the intestines.
Generally, a healthcare professional will advise a person to refrain from eating 4 hours before surgery, though they may consume clear fluids up to 2 hours before the procedure.
The healthcare professional will also advise that the person leaves valuable items such as jewelry at home.
On the day of surgery, a person will need to bring certain items to the hospital or medical center. These may include:
- a list of all prescription medications, over-the-counter medications, herbal remedies, and other supplements they are using
- their insurance information and identification
- comfortable, loose-fitting clothing
- shoes that do not require bending over to put on
- an advance health directive
The discussion with the anesthetist on the day of surgery should include the following points:
- any allergies the person has
- any preexisting health conditions they have
- any loose teeth they have
- any details on their alcohol or drug use
Colectomies take place under general anesthetic. They may be either laparoscopic-assisted or open surgery.
During laparoscopic colectomy, a surgeon will insert tiny flexible ports or tubes through incisions in the abdomen. They will insert lights and other surgical tools through these ports or tubes.
They can then remove the diseased or damaged portion of the colon and either sew the two ends together or create a stoma.
In open colectomy, a surgeon will access the colon through an incision in the abdomen and remove the section of the colon that is diseased or damaged. They may also remove some of the surrounding healthy tissue.
They will then stitch or staple the ends together, known as anastomosis, or create a stoma.
If the procedure is for the treatment of cancer, the surgeon may also remove some of the lymph nodes near the colon for microscopic examination to check for cancer.
The procedures that take place during colectomy surgery depend on how much of the colon requires removal.
- Sigmoidectomy: This refers to the removal of the sigmoid colon, which is the curved portion of the descending colon that connects to the rectum.
- Right hemicolectomy: This refers to the removal of the right, or ascending, colon.
- Left hemicolectomy: This refers to the removal of the left, or descending, colon.
- Segmental resection: This refers to the removal of short segments of the colon.
- Total colectomy: This refers to the removal of the entire colon. A surgeon will then attach the small intestine to the rectum.
- Low anterior resections: This refers to the removal of the upper rectum.
- Transverse colectomy: This refers to the removal of the middle bowel, or the transverse colon.
- Abdominal perineal resection: This refers to the removal of the rectum, anus, and sigmoid colon and the attachment of permanent colostomy.
- Total proctocolectomy: This refers to the removal of all or part of the colon and the rectum.
When is a stoma necessary?
A stoma may be necessary if the surgeon cannot sew or staple the two separated ends of the intestine together. Instead, in a procedure called colostomy, they will attach a bag to collect feces to an opening on the outside of the body.
The stoma may be temporary, and the surgeon may surgically remove it after the lower colon has healed. During the second surgery, they will reattach the colon inside the body. However, the stoma may be permanent.
People should discuss the potential benefits, risks, and complications of colectomy with a healthcare professional.
Risks and complications that are commonly associated with colectomy include:
- leakage of the colon contents into the abdomen
- pneumonia and other lung problems
- blood clots in veins or the lungs
- postoperative bleeding
- gastrointestinal fistula, or an unusual connection between two body parts
- organ or tissue adhesions
- stroke or heart attack
When to seek medical advice
People should ask a healthcare professional when to seek medical advice or care after surgery.
In general, they should seek medical advice immediately if they experience any of the following symptoms:
- continued nausea
- leakage or drainage from the wound
- severe pain
- abdominal cramping
- a bad smell or drainage coming from the incision
- increased swelling or flushing around or over the incision
- blood in the stool
- a swollen abdomen
- no bowel movements for 2–3 days
Most people stay in the hospital for 3–4 days after laparoscopic-assisted or open colectomies, unless there are complications.
People who experience vomiting, nausea, or an inability to pass urine may need to stay in the hospital for a longer time.
After a person has their first bowel movement after surgery, usually within 3–4 days, they can return to eating normally.
Many people return to their regular activities 1–2 weeks after laparoscopic-assisted surgery and 2–3 weeks after open surgery.
People should avoid engaging in strenuous activities, working out, and lifting anything heavier than 10 pounds for 4–6 weeks after colectomy surgery.
A person’s outlook after colectomy surgery depends on several factors, including:
- the severity or extent of their colon disease or damage
- how much of the colon and surrounding tissues the surgeon removed
- any complications that occurred during or after surgery
- the person’s overall health
- the person’s age
One study involving people who had undergone colectomy for ulcerative colitis found that
Colectomy refers to a type of surgery to remove all or some of a diseased or damaged colon.
Most people spend a few days in the hospital after colectomy surgery but can return to most non-strenuous activities within 1–4 weeks.
Some people may need to use a colostomy bag.