Colectomy
Colectomy, also known as colon resection or large bowel resection, is a surgical procedure involving the removal of part or all of the colon. This surgery may entail connecting the remaining ends of the bowel through an anastomosis or creating an ostomy, where a new opening is formed in the abdomen. Colectomy is typically performed to treat colon cancer, remove precancerous lesions, or manage conditions such as obstructions or perforations. Various types include right hemicolectomy, left hemicolectomy, and total colectomy, among others.
Prior to the surgery, patients undergo extensive preparation and medical evaluations to ensure they are fit for the procedure. The process is performed in a hospital setting under general anesthesia and can be approached through traditional open surgery or minimally invasive laparoscopic techniques. Post-surgery, patients often require recovery support and may be prescribed medications to manage pain and prevent infection. While colectomy can be life-saving and curative for many, it does come with potential risks and side effects, which can range from infections to complications related to anastomosis or ostomy. Long-term outcomes depend on various factors, including the stage of cancer and overall patient health.
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Subject Terms
Colectomy
ALSO KNOWN AS: Colon resection, large bowel resection, large intestine surgery
DEFINITION: Colectomy is the surgical removal of part or all of the colon. Either the two remaining ends of the bowel are connected (anastomosis), or the lower end is sealed and the upper end rerouted to a new opening (ostomy) in the abdomen, forming a stoma. The ostomy may be temporary or permanent. Types include right hemicolectomy, left hemicolectomy, sigmoidectomy, total colectomy, total proctocolectomy, and subtotal colectomy.
Cancers treated:Colon cancer
Why performed: For patients at high risk for colon cancer, like those with familial adenomatous polyposis (FAP) or Lynch syndrome, a colectomy is performed to remove precancerous lesions or to prophylactically remove the entire colon, thereby preventing the disease. For patients with colon cancer, colectomy is performed to remove the diseased colon segment with a margin of healthy tissue and all draining lymph nodes, as well as other lesions and involved structures, thereby curing or controlling the disease. For patients with advanced colon cancer, a colectomy is performed to manage obstructions, perforations, hemorrhages, or other symptoms.
Patient preparation: Medical tests help plan effective treatment and evaluate the patient’s fitness for major surgery. If an ostomy is needed, a specialist counsels the patient and helps choose the location for the stoma. For the colectomy, certain patient medications may need to be stopped, the patient’s bowel must be cleaned, and the patient’s stomach must be emptied.
In an emergency, patient evaluation and preparation may be limited. If the patient’s colon is partially obstructed, the obstruction is relieved before the colectomy. If the patient’s colon is fully obstructed, perforated, bleeding profusely, or if the bowel cannot be prepared, an emergency surgery (colectomy or an alternative) is performed once the patient is stable.
Steps of the procedure: Colectomy is performed in a hospital. Before the surgery, sensors are placed to monitor the patient’s condition. An antibiotic is infused through an intravenous (IV) line. A general anesthetic is administered, and a breathing tube is placed. The patient is positioned, a urinary catheter is inserted, and the incision site is prepared. If appropriate for the patient, the procedure may be performed using laparoscopic surgery.
Colectomy has four stepsopening and evaluation, tissue removal, anastomosis or stoma formation, and inspection and closure. Details vary with the part(s) of the colon involved (ascending, transverse, descending, or sigmoid); why the colectomy is needed (prevention, cure/control, or relief); and the surgical approach chosen (open or laparoscopic). In an emergency, these steps may be reordered or performed as separate procedures.
To begin, the surgeon opens the abdomen with one large incision; four to five small incisions, when using a laparoscope; or a combination of these approaches. Within the abdomen, the surgeon looks for cancer and other abnormalities, then evaluates the colon segment to be removed. If the colon segment cannot be removed safely, then a bypass procedure is performed instead. If the colon segment is removable, then the colectomy continues.
To remove tissue, first, the major blood vessels to that colon segment are tied. The colon segment is freed from attachments. The mesentery for that colon segment is clamped and divided; the tied blood vessels are divided and sealed; and then that colon segment is divided and removed, as well as any adjacent tissues that are diseased. All tissues are taken to the laboratory for histopathologic evaluation.
Either the remaining ends of the bowel are connected, forming an anastomosis (colo-colo, colo-rectal, or colo-anal), or the lower end is sealed and the upper end rerouted. When rerouting, first, an ostomy opening is made in the abdomen. The upper end is passed through the ostomy opening; the bowel segment is sized to an appropriate length, and the edge of the cut end is folded back and stitched to the abdomen, forming a stoma.
Finally, the inside of the abdomen is inspected and cleaned, and the incision is closed.
After the procedure: Anesthesia is stopped, and the breathing tube is removed. The urinary catheter and the IV line are kept. If an ostomy is needed, a clear collection pouch (ostomy appliance) is fitted over the stoma. The patient is transferred to the recovery room and then a hospital room. Medications are given to control pain and infection. The patient slowly progresses to a normal diet and learns to regulate bowel function. If an ostomy is needed, it is monitored. Once the stoma starts functioning, the patient learns to care for it and empty and change pouches. At home, the patient follows the physician’s instructions about medications, activities, and diet. Additional treatment with radiation therapy, chemotherapy, or both may be recommended.
Risks: Colectomy is moderately safe with low mortality, but emergencies are riskier. The risks relate to anesthesia, infection, and inadvertent damage to structures. Side effects are common, with the most frequent being urinary infection, wound infection, and problems related to anastomosis or ostomy. Less frequent side effects are bleeding, perforation, abscess, fecal contamination, incisional hernia, bowel obstructions, and peritoneal seeding.
Results: Long-term outcome varies with patient-specific factors (such as life-threatening conditions, disease stage, and overall health) and therapeutic combinations (such as type of radiation therapy, chemotherapy, or both after surgery). Curative removal is possible for many first-time patients, but otherwise, the recurrence rate is high. Five-year survival is excellent for patients with localized cancer but is poorer for patients with more advanced disease.
Bibliography
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