A colectomy is surgery to remove the colon (large intestine) to treat various medical conditions. It is the primary treatment for colorectal cancer and is often curative. A colectomy, or colon resection, may involve removing all or part of the colon, depending on the specific condition treated.

In a partial colectomy, the surgeon removes the part of the colon that contains the cancer, along with a portion (margin) of surrounding normal tissue. A “clean margin” helps assure there are no malignant cells left in the area. The remaining portion of the colon is then sewn back together. In a total colectomy, the entire colon is removed. In such cases, a colostomy is also necessary to provide the patient with an alternate way to eliminate wastes from the body.

Increasingly, laparoscopic surgery is being used to perform colectomy and other colorectal cancer treatments. It uses several small incisions in the abdomen and a long, narrow tube called a laparoscope. The laparoscope is inserted into the body cavity and surgical instruments are used to remove cancerous sections of the colon. Compared to traditional colectomy surgery, laparoscopic surgery involves smaller incisions, is less likely to cause significant scarring and may result in faster recovery with less pain.

A colectomy is surgery to remove all or part of the colon, which is the large intestine, measuring  about 5 feet (150 centimeters) long. The colon stores and mobilizes waste until it is eliminated from the body. It extends from the small intestine to the rectum, which is the lower 6 inches (15 centimeters) or so of the large intestine. A hemicolectomy (removal of about one-half of the colon) is the primary treatment for colorectal cancer. The amount of colon removed during the procedure depends on how extensive the cancer has penetrated the wall of the bowel. It also depends on whether or not the cancer has metastasized (spread) to the lymph nodes or other areas of the body.

Most people have a good outcome following a colectomy. Statistics reveal no recurrence of cancer in more than 80 percent of early-stage patients more than four years after surgery, according to the American Academy of Family Physicians.

The types of colectomies include:

• Total colectomy. The entire colon is removed.
  
  
• Right hemicolectomy. Right part of the colon is removed. This procedure is called ileocolectomy when the lower small intestine is removed as well.
  
  
• Left hemicolectomy. Left portion of the colon is removed.
  
  
• Segmental resections or partial colectomies. Smaller colon segments are removed.

During a colectomy, the surgeon removes the part of the colon that contains the cancer. A portion (margin) of surrounding normal tissue is also removed to reduce the chances of stray cancer cells remaining in the body. Nearby lymph nodes may be removed for biopsy to determine if the cancer has spread.

The surgeon will then try to reconnect the healthy portions of the colon or rectum. In some cases, this is not possible because of the location of the cancer or other factors. In such situations, the patient may need an operation known as a colostomy. This procedure temporarily or permanently redirects body waste to an opening created in the patient’s abdomen where it is drained from the body into an attached bag.

Colectomy is also used to treat other medical disorders that may or may not be related to colorectal cancer. For example, a rare, inherited syndrome known as familial adenomatous polyposis (FAP) sometimes requires removal of the entire colon and rectum. This procedure is known as ileal pouch-anal anastomosis, in which the surgeon usually constructs a pouch from the end of the small intestine that attaches directly to the anus. Waste is then expelled normally, although bowel movements frequently are watery.

Other conditions that may require a colectomy include:

• Precancerous polyps
• Diverticular disease
• Intestinal blockage due to scar tissue
• Chronic inflammatory bowel disease, such as ulcerative colitis or Crohn's disease
• Fecal incontinence
• Traumatic injuries

Generally a blood sample is drawn prior to surgery, and depending on the physical condition of a patient, a chest x-ray, electrocardiogram or other tests may be performed. In some cases, the patient may receive chemotherapy, radiation therapy or both to shrink the cancerous tumor prior to the colectomy.

Prior to the surgery, the patient typically is given instructions for cleaning out the colon. This process may include using laxatives or enemas. Although this may be uncomfortable, it is important that the patient follow these and any other preparatory instructions given by a physician. The patient will be restricted from eating or drinking anything after midnight the night before the operation.

During the traditional open surgery, the patient is placed under general anesthesia and is not awake for the procedure. The surgeon makes an incision in the abdomen and removes the part of the colon that contains the cancer along with a portion (margin) of surrounding normal tissue. This helps ensure that all the cancer is removed from the area. Nearby lymph nodes may be removed for biopsy to determine any spread of the disease.

If possible, the two healthy ends of the colon are sewn back together (anastomosis) and the abdominal incision is closed. The average open colectomy takes less than two hours.

In cases where a substantial portion of the colon has been removed, the remaining portion of the colon may not be attached. In this case, the patient will need to have a colostomy that redirects waste to a special bag attached to an opening created in the abdomen. In some patients, the colostomy is only temporary to allow the colon or rectum time to heal without being exposed to the wear and tear of the fecal flow. However, in other situations the colostomy may be permanent.

After the surgery, patients often receive oxygen through a mask or nasal tube. They typically experience pain and may need medications, such as morphine for a few days. Following surgery, patients are given intravenous fluids and are not allowed to eat. Within a few days, most patients are eating again, though the diet may be restricted. 

Patients generally stay in the hospital for five to seven days following the surgery. Complete recovery from surgery may take up to two months. chemotherapy and/or radiation therapy may be necessary following surgery for cancer treatment. The patient's cancer care team, including medical and radiation oncologists, will determine any necessary treatments.

Patients who have a partial colectomy for lesions above the lower rectal area will continue to eliminate waste through the colon, rectum and anus. Patients who have a total colectomy, however, will need to make several adjustments in their lifestyle. A physician may recommend the following to patients who have undergone colectomy:

• No heavy lifting. Restrictions may last six weeks or more during healing.
  
  
• Avoid abdominal exercises, such as pushups and sit-ups.
  
  
• Take part in other exercise. Patients should walk to help strengthen muscles, keep blood circulating, prevent clotting and keep lungs clear. Patients may return to exercise according to a physician’s guidelines.
  
  
• Follow a soft diet. Patients should refrain from eating raw fruits or vegetables until they have a post-surgical checkup and their physician approves a return to a normal diet.

As with any surgery, there are risks associated with anesthesia (e.g., allergic reactions, cardiac and breathing difficulties) and the surgery itself (e.g., infection, bleeding, cardiac complications). Common side effects associated with colon surgery include short-term pain or tenderness and temporary constipation or diarrhea. The more serious risks associated with colectomies include:

• Bulging through the incision (incisional hernia)
• Narrowing (stricture) of the stoma
• Scar-issue blockage of the large intestine
• Leakage after the intestine is reconnected
• Injury to adjacent organs (e.g., small intestine, bladder)

Patients will continue with follow-up visits to monitor the healing process and the colostomy, if it has been performed. Physicians may also recommend support groups to help these patients deal with lifestyle changes from the procedures.

A procedure known as laparoscopic-assisted colectomy (LAC, also called laparoscopic intestinal surgery) is being used more frequently to treat colorectal cancer. Laparoscopy traditionally has been used to investigate medical conditions inside the abdominal cavity. It uses a long, narrow tube called a laparoscope that is inserted into the body cavity through very small incisions.

This technique is now being used to treat some cases of colorectal cancer. Traditional open intestinal colon surgery requires a long abdominal incision and a lengthy recovery. By contrast, LAC requires five or six small (2-inch/5–millimeter) incisions in the abdomen. The laparoscope and surgical instruments are inserted through these incisions. The laparoscope transmits images of the intestinal organs on a video monitor while the surgeon performs various procedures. LAC may take longer and cost more than open colectomy, which typically lasts less than two hours. However, because the procedure is much less invasive, hospitalization and recovery times are usually shorter.

Compared to traditional intestinal surgery, the patient may experience less pain and scarring and lower infection risk. Not all patients are candidates for laparoscopic surgery for a colectomy. Individuals who are obese, who have abdominal scar tissue or large tumors may need to undergo conventional surgery. In some cases, surgeons may begin LAC but may have to convert to open surgery due to problems, such as visualizing the organs.

Researchers are investigating the survival rate of patients after LAC as compared to those who received traditional open colectomy. To date, researchers have found a three-year survival rate of about 86 percent for both types of surgery. Minimally invasive laparoscopic surgery is considered a safe and effective alternative to traditional surgery for patients with cancer that has remained confined to the colon.

Preparing questions in advance can help patients have more meaningful discussions with their physician. Patients may wish to ask their doctors the following questions about colectomy:

1. What determines the need for a colectomy?
   
   
2. What are the risks associated with colectomy?
   
   
3. How can you determine how far the cancer has spread in my colon?
   
   
4. Will I need to have partial or total colectomy?
   
   
5. Do I have any other treatment options?
   
   
6. Will you remove lymph nodes during the procedure? If so, when will I know of the biopsy results?
   
   
7. Can the procedure be performed laparoscopically?
   
   
8. Will I need a temporary or permanent colostomy?
   
   
9. What can I expect in terms of recovery from a colectomy?
   
   
10. What are my restrictions following the procedure?
    
    
11. Will I need any radiation therapy or chemotherapy before or after the procedure?
    
    
12. What are the chances the cancer will return to the remaining colon?
    
    
13. How will my condition be monitored?
    
    
14. What is my prognosis after the colectomy?