Surgery for Rectal Cancer

Surgery for rectal cancer has advanced a great deal over the last decade. 10 to 15 years ago, if surgeons wanted to remove a tumor in the lower third of a patient’s rectum, they usually had to remove the anal sphincter muscle as well. To allow for the drainage of stool, they would then create an opening in the abdomen where a bag collects solid waste (ostomy).

Today, if the tumor does not directly involve the sphincter muscle or pelvic floor, Washington University colorectal surgeons at Siteman are frequently able to remove it while leaving these important structures intact. These “sphincter-sparing” procedures allow patients to maintain normal bowel function.

Types of surgery for rectal cancer

Transanal endoscopic microsurgical (TEM) excision for rectal cancer

Some rectal cancer patients at Siteman will require a procedure called transanal endoscopic microsurgical (TEM) excision. Our colorectal surgeons helped pioneer this procedure, which involves removing benign polyps and early cancers through the anus. The approach is minimally invasive and allows for better visualization and access to nearby lesions than traditional methods of rectal surgery. Doctors are also using TEM with radiation therapy to remove more advanced cancers in appropriate patients.

Metastasectomy for rectal cancer

If your cancer has spread to other organs in your body, surgeons might be able to perform a metastasectomy. This procedure removes colorectal cancer from another organ, such as the liver or the lungs. Surgeons at Siteman are skilled at these procedures and will try to find ways to eliminate rectal cancer from more distant areas.

What is an ostomy?

An ostomy is a mechanism to allow for the drainage of waste if the colon is unable to function. Surgeons will create an opening (stoma) from the colon to the outside of the body. A bag covers the opening and collects stool as it drains. In most cases, ostomies are temporary measures that allow the colon to heal following a partial colectomy. This is rarely a long-term solution for colon cancer patients.

If you receive an ostomy after rectal cancer surgery, a special ostomy nurse will train you how to use it and care for it.

Are ostomies permanent?

Sometimes. Despite the new methods and techniques available today, a small percentage of patients will still need permanent ostomies due to the location and characteristics of their tumors. These patients will receive ongoing support from designated nurses and experienced enterostomal therapists.

I'm self-conscious about having an ostomy bag. Will it be visible through clothing?

Ostomy bags are designed to be slim and to block any smell from escaping, which can make them practically undetectable underneath clothes. There are ways to conceal your bag in almost any situation. There are articles of clothing (including swimwear and underwear) specially designed to help conceal your bag. You can also get decorative sleeves and pouches designed for ostomy bags for everyday use.

Can you swim with an ostomy bag?

You can still swim with an ostomy bag! They are specially designed to be water-resistant. Some adjustments (like ensuring a good seal before and after swimming, and protecting your stoma in situations where it may be bumped or irritated) are unavoidable, but such adjustments do not mean you have to abandon your favorite activities.