While the health information and fact sheets on this website relate to world-wide situations, the drug names will vary between countries – therefore the advice of your local GP should be sought.
|The health information and factsheets on this website are produced by Bupa's health information team. The information is reviewed and approved by relevant healthcare professionals, including doctors, dentists, nurses, physiotherapists and dietitians.||
|Browse the a-z list of factsheets:||
Bowel cancer surgery
Published by Bupa's health information team, February 2009.
This factsheet is for people who are planning to have bowel cancer surgery, or who would like information about it.
Bowel cancer is caused by uncontrolled growth of cells in the lining of the bowel that form a tumour. The aim of bowel surgery is to remove the tumour and help decide if further treatment is necessary.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.
About the large bowel
The large bowel, also called the colon, is the lower part of your digestive system. It absorbs water and nutrients from digested food that passes through it. The rectum, at the end of your colon, is where faeces collect before they go out through your anus as a bowel movement.
The location of the large and small bowel
Bowel cancer, also known as colorectal cancer, is the name for any cancer of the colon and rectum. Surgery is usually recommended for bowel cancer.
What are the alternatives to surgery?
Your treatment options will depend on the type of cancer you have and how much of the bowel is affected. Very rarely, colonoscopy is used to remove small tumours.
Medicines (chemotherapy) or radiation may be used to shrink the tumour before surgery or after surgery to reduce risk of re-occurrence.
Preparing for your operation
The traditional approach (open bowel surgery) usually requires a hospital stay of seven to ten days. Laparoscopic (keyhole) surgery may require a shorter stay of three to five days.
You will usually be asked to attend a pre-assessment clinic for routine tests a few days before your admission. Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
Your bowel has to be completely empty before the operation. You may be asked to follow a special diet for a day or two and you may be given laxatives to take the day before surgery.
The operation is usually done under general anaesthesia. This means you will be asleep during the procedure. You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.
At the hospital your nurse may check your heart rate and blood pressure, and test your urine.
You may also be given a bowel washout (an enema). A tube is passed into your rectum and the remaining contents of your bowel are flushed out using water.
Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, compression stockings.
About the operation
The operation can be done using open or keyhole surgery and usually takes two hours.
Open surgery - a single large cut is made over your abdomen.
Keyhole surgery - several small cuts (up to five) are made in your abdomen. A tube-like telescopic camera is passed through a cut to view the area and the operation is done using special instruments.
The diseased part of the colon is removed and the two healthy ends are joined together using stitches or staples. How much of the colon is removed depends on the position and size of the cancer and how advanced it is. Lymph nodes near the bowel are often removed to help determine if the cancer has spread and if further treatment is needed.
Sometimes, it isn't possible to rejoin the colon. In these circumstances, the colon is brought to the surface as a stoma. A bag is worn over the stoma which collects waste from your bowel. This is called a colostomy. This is usually temporary but can be permanent. Your surgeon will discuss this with you beforehand.
You will usually be given antibiotics during surgery to reduce your risk of infection.
What to expect afterwards
You will be taken from the operating theatre to the high dependency unit where you will be closely monitored for around 24 hours. You will be connected to machines that monitor the activity of your heart and other body systems. You will have a drip in your arm to keep you hydrated. Once the medical team is happy with your progress, you will be taken back to your room.
You will need pain relief as the general anaesthetic wears off. Controlling pain after an operation is very important because pain can interfere with your recovery. You may be offered patient controlled analgesia (PCA). This is a pump connected to your cannula that allows you to control how much pain medicine you have.
When you no longer need intravenous medicines and are able to drink enough fluids, the cannula and drip will be removed.
On the first day, you may have to wear special pads, attached to an intermittent compression pump, on your lower legs. The pump inflates the pads and encourages healthy blood flow in your legs and helps to prevent DVT. You may also have compression stockings on your legs to help maintain circulation.
You will have a fine tube (catheter) fitted to drain urine from your bladder into a bag. This will usually be removed when you are ready to get out of bed and walk around.
You will be encouraged to get out of bed and move around as soon as possible as this helps prevent chest infections and blood clots in the legs. You may have daily injections for a few days to help prevent blood clots.
Your surgeon will visit you to assess your progress and answer any questions you have about the operation.
If you have a stoma, a nurse specialist will visit you to help you learn how the bag works and to provide support and advice.
You may find that you don't have any bowel movement for several days. If you don't have a stoma, try not to strain when you go to the toilet. Laxatives will be available if you need them. You may see blood in your faeces for a few days.
Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Recovering from bowel surgery
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Follow your surgeon's advice about strenuous exercise, lifting and driving. You shouldn't drive until you feel confident that you could perform an emergency stop without discomfort. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.
A full recovery can take up to 12 weeks.
What are the risks?
Bowel surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted but mostly temporary effects of a successful operation, for example feeling sick as a result of the general anaesthetic.
Side-effects of bowel surgery include:
pain and discomfort in your abdomen for the first few weeks
scarring - scars are usually permanent but should fade gradually over time
This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Complications specific to bowel surgery are uncommon but can include:
infection - antibiotics are given during surgery to help prevent this, but a serious infection may need further surgery
damage to internal organs - this can be fatal
failure of new join - the new join may fail and leak, and will need further surgery
bleeding under your skin (haematoma) - this may require surgery to stop the bleeding and drain the area
numbness - nerves can be damaged during surgery, this can lead to loss of sensation and very rarely it can affect sexual or bladder function
unusually red or raised scars (keloids) - these can take a long time to heal
hernia formation - rarely, a hernia can occur at the surgical site
If you are having keyhole surgery, there is a chance your surgeon may need to convert your keyhole procedure to open surgery.
The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
Bowel cancer surgery Q&As
See our answers to common questions about bowel cancer surgery, including:
- Surgery for bowel cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 30 June 2008
- Colorectal cancer - laparoscopic surgery TA105. National Institute for Health and Clinical Excellence (NICE), 2006. www.nice.org.uk
- Venous thromboembolism (surgical) - reducing the risk of thromboembolism (DVT and pulmonary embolism) in inpatients undergoing surgery. National Institute for Health and Clinical Excellence (NICE), 2007. www.nice.org.uk
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: February 2009