How is laparoscopic surgery for colon cancer performed?

Laparoscopic surgery for colon cancer is performed by inserting a camera and instruments through several small abdominal incisions. The section of bowel containing the tumour is removed together with its associated lymph nodes, and the remaining ends are joined if conditions allow. The word laparoscopic describes how the surgeon gains access; the tumour's location and extent of spread determine how much tissue needs to be removed.

For a suitable patient, this approach may offer smaller wounds and a faster recovery, but the same plan is not chosen in every situation. The operation may need to start as open surgery or change to a larger incision during the procedure. The main aim is to remove the tumour completely, together with the necessary surrounding tissue, and complete the operation safely.

Which part of the bowel is removed?

The colon runs up the right side of the abdomen, across it, down the left side and through the sigmoid colon to the rectum. A tumour on the right may require removal of the right section, one on the left may require removal of the left section, and one in the sigmoid colon may require removal of that segment. Removal of a section of bowel is called resection, while partial or complete removal of the colon is called colectomy.

As well as the visible tumour, the surgeon removes a margin of healthy tissue on either side and tissue along the blood vessels supplying that area, so that the diseased area is removed in its entirety. These margins allow examination under a microscope to establish whether tumour cells remain at the edges.

Lymph nodes are small tissue structures belonging to the immune system. Because cancer cells can spread from the bowel to the lymph nodes, these are also removed and examined under a microscope, helping to determine the stage of the disease and whether additional drug treatment is needed. Normal-looking lymph nodes on imaging do not replace this examination.

Removing the entire colon is not part of every cancer operation. More extensive surgery may be needed for tumours in several locations, certain inherited conditions or numerous tissue growths called polyps. An example of an extended right colectomy for a tumour in the transverse colon can be seen in this video. This is surgical footage intended for adults and shows an operation tailored to a particular patient's anatomy.

What happens in the operating theatre?

Before surgery, the team reviews examinations showing the tumour's location and spread, the pathology results and the patient's general health. The anaesthetist, the doctor responsible for anaesthesia and monitoring vital signs during surgery, asks about heart and lung conditions, medicines and previous experiences of anaesthesia. The surgical team provides separate instructions on bowel preparation and fasting.

You are asleep throughout the operation. Under general anaesthesia, carbon dioxide is introduced into the abdominal cavity to create enough space for the surgeon to work with the instruments and for the camera to provide a clear view. Watching the images from the camera inserted through a small incision on a screen, the surgeon uses instruments to separate the bowel from surrounding tissue and secure the blood vessels supplying the section to be removed.

Once the tumour-bearing section has been separated together with its lymph nodes, one incision may be enlarged to remove the tissue from the body. The remaining bowel ends are joined with stitches or a special device. This join is called an anastomosis. Its blood supply and whether the ends can be joined without tension are assessed.

A tumour on the left involves a different section of bowel and different blood vessels. Removal of cancer at the bend in the colon near the spleen is shown in the video Laparoscopic left hemicolectomy for splenic flexure cancer. This is also surgical footage intended for adults; whether the technique shown is relevant to your operation depends on the tumour's location.

When are a stoma and open surgery needed?

If the bowel ends cannot be safely joined at that time, a stoma may be created. A stoma is an opening of the bowel brought out onto the abdominal wall; stool passes through it into a special bag. An opening made from the colon is called a colostomy, and one made from the small bowel is called an ileostomy. Whether it is temporary or permanent depends on the reason for surgery and the remaining bowel.

A stoma is not always needed. However, if the bowel is blocked, a hole has developed in its wall, there is infection in the abdominal cavity or there are concerns about healing of the join, the surgeon may consider creating a stoma safer. If this is a possibility before surgery, the surgeon will discuss the reason and the subsequent plan with you.

Spread of the tumour into a neighbouring organ, adhesions from previous operations, bleeding or an inadequate view may make a switch to open surgery necessary. This is a surgical decision made to allow the operation to proceed safely. The name of the technique alone does not determine the outcome.

Hospital stay and the first days of recovery

After uncomplicated laparoscopic surgery, the hospital stay is often a few days; some recovery programmes anticipate about 3 to 5 days. It may be longer. Bowel function, the ability to eat and drink, pain control and independent mobility, as well as other medical conditions, affect when discharge is possible.

The team plans early mobilisation and a return to eating as your condition allows. Medication and other measures may be used to prevent blood clots in the legs. If you have a stoma, you will be taught how to care for it and change the bag before going home. Written information should be provided about medicines, wound care and the department to contact.

Possible complications include bleeding, infection, delayed return of bowel function and leakage from the join. Increasing abdominal pain, fever, persistent vomiting or pus from the wound after discharge need urgent assessment. Call emergency services if you have chest pain, sudden shortness of breath or fainting.

How is the decision about chemotherapy made?

After surgery, the final pathology report on the removed tissue shows how deeply the tumour has grown into the bowel wall, the findings in the lymph nodes and the resection margins. Chemotherapy is drug treatment that acts on cancer cells. When given after surgery, it aims to target residual cells that cannot be seen and reduce the risk of recurrence.

In stage III disease, where cancer has spread to the lymph nodes, chemotherapy after surgery is usually recommended. In stage II disease, without lymph node spread, not every patient needs it; tumour growth through the bowel wall, obstruction, perforation and other risk factors are considered. Laboratory results relating to the system that repairs errors in tumour cells' genetic material may also affect the choice of drug treatment. At an earlier stage, surgery alone may be sufficient.

Dr. Ilgar Ismayilov performs laparoscopic surgery for bowel cancer. If additional treatment is needed, its benefits, possible side effects and timing are discussed based on the surgeon's and oncologist's assessment. Bringing the operation record and final pathology report to this appointment makes it easier to follow which information the decision is based on.