At Dana-Farber Brigham 91精品, rectal cancer surgery is performed by board-certified colon and rectal surgeons from Brigham and Women’s Hospital. Our surgeons use the most advanced technology available and perform leading-edge, minimally invasive procedures whenever appropriate. They are part of a highly experienced team that includes medical and radiation oncologists, gastroenterologists, anesthesiologists, and pathologists—all working together to provide expert, personalized care for every patient.
This surgery is used for early-stage rectal cancer found in the lower part of the rectum. The surgeon removes the small tumor through the anus using special tools, so there’s no need for a big incision or a permanent colostomy. The area is stitched closed after the tumor is taken out, and nearby lymph nodes may also be removed to check for cancer. Because this is a less invasive procedure, it’s sometimes done as an outpatient surgery. Patients may still need follow-up treatment like chemotherapy or radiation, and regular checkups are important to make sure the cancer doesn't return.
These are essentially two similar procedures that are used when tumors are larger or located higher up in the rectum, making them harder to reach. A doctor uses a special device (a rigid instrument called rectoscope in TEM, or a gel-like round port containing a camera and surgical tools in the case of TAMIS), to see and remove the tumor through the anus. Since there are no cuts made in the abdomen, patients usually recover faster and with less pain. This approach helps doctors remove tumors that previously required major open surgery. Most people go home the same day and can return to their regular activities within a couple of days.
This surgery treats cancer found in the middle or lower parts of the rectum. The surgeon removes the section of the rectum that has the tumor, then connects the remaining colon to the rectum or anus so that stool can still pass naturally. In some cases, a temporary bag called an ileostomy is needed to help the area heal properly. This bag is usually removed in a second surgery after a few months. The goal of LAR is to remove the cancer while still preserving normal bowel function.
This operation is used for cancers located very low in the rectum, especially if the cancer involves the sphincter muscles that control bowel movements. In this case, the rectum, anus, and sphincters are all removed, and the patient will need a permanent colostomy. Before surgery, patients meet with a specialist to learn about living with a colostomy and how to care for it. Many people adjust well and continue to live active, full lives after this surgery.
If rectal cancer has spread to nearby organs in the pelvis, a more complex surgery called pelvic exenteration may be needed. During this operation, the surgeon removes the rectum and any organs that are affected, such as parts of the bladder, reproductive organs, or other tissue. After removing the cancer, the surgeon rebuilds the area as much as possible. Most patients will need a permanent colostomy, but this surgery offers the best chance to remove all the cancer when it has spread.
Sphincter-sparing surgery is a treatment option for some people with rectal cancer, especially when the tumor is close to the anus. The sphincter is a ring of muscles at the end of the rectum that controls bowel movements. If the sphincter is removed or damaged during surgery, a person may lose the ability to control their bowel movements and need a permanent colostomy bag. This bag collects stool through an opening in the belly. To help patients avoid this, doctors sometimes use sphincter-sparing surgery. This type of surgery removes the cancer and a small amount of healthy tissue while keeping the sphincter muscles in place. It may be followed by chemotherapy and radiation to lower the chance of the cancer coming back. This surgery can be done through the anus (transanal excision) or through the tailbone (transcoccygeal excision), depending on where the tumor is. Not everyone is a candidate for this approach. It usually works best for early-stage rectal cancers that are small and located far enough from the sphincter to be safely removed without damaging it.
Minimally Invasive Rectal Cancer Surgery: At Dana-Farber Brigham 91精品, our expert surgeons use minimally invasive techniques to treat rectal cancer whenever possible. These advanced methods involve making small cuts in the body to remove the tumor, which means less pain, a shorter hospital stay, and a quicker return to normal activities. Minimally invasive surgery also lowers the risk of infection, reduces blood loss, and results in smaller scars. Our team specializes in these techniques and continues to improve how they are used, offering patients safer and more effective options for rectal cancer treatment.
Robotic-Assisted Surgery for Rectal Cancer: Robotic-assisted surgery is one of the most advanced forms of minimally invasive surgery we offer at Dana-Farber Brigham 91精品 for rectal cancer. During this procedure, the surgeon sits at a special console and uses hand and foot controls to guide robotic arms. These robotic tools move with greater precision than human hands and are equipped with a high-definition 3D camera that gives a close-up, magnified view of the surgical area. This allows the surgeon to carefully remove rectal tumors, especially those located deep in the pelvis. Robotic-assisted surgery can lead to better outcomes, fewer complications, and a smoother recovery for many patients with rectal cancer.
Preparing for surgery is an important part of your treatment. It’s helpful to arrange transportation to and from the hospital and organize support for daily tasks during your recovery. Before your procedure, your care team will provide specific instructions, which may include eating a healthy diet, exercising regularly, limiting alcohol, and stopping smoking if possible.
You will also have a preoperative appointment either at the Roberta and Stephen R. Weiner Center for Preoperative Evaluation or over the phone, depending on your doctor’s recommendation. A nurse practitioner will review your medical history, current medications, and may order lab tests or an to check your heart. This helps ensure you are medically ready for surgery. A social worker may also be involved to help plan for any support needed after surgery.
Usually, the day before surgery you will take a mechanical bowel clean out and oral antibiotics that help clean and sterilize the colon and rectum.
On the day of surgery, a team of rectal cancer specialists—including surgeons, anesthesiologists, and nurses—will provide care throughout the procedure. The surgery may take several hours, depending on the type.
After surgery, you will recover in a monitored area. Nurses will check your vital signs and make sure you are stable as the anesthesia wears off. Some patients may return home the same day, while others may stay in the hospital for a few days. Pain is common after surgery, but your care team will provide medications and strategies to manage it. Before discharge, you will receive detailed instructions about medications, incision care, and activity restrictions.
Recovery time varies based on the type of surgery and your overall health. It is common to feel tired or have some pain in the days and weeks after surgery. Constipation may occur due to medications, reduced activity, or changes in diet. Your healthcare provider can recommend ways to manage this.
Strenuous activities should be avoided while your body heals. Your care team will let you know when it is safe to return to daily routines, including work. It is important to follow post-surgery instructions carefully and reach out to your team if you have any concerns or questions about your recovery.
At Dana-Farber Brigham 91精品, we are always working to improve surgical care for people with rectal cancer. Depending on how advanced your cancer is, your doctor may talk to you about needing an ostomy. An ostomy creates an opening in the abdomen so waste can leave the body. In the past, people with rectal cancer often needed a permanent colostomy, where the rectum is removed and waste passes through a stoma (an opening in the abdomen) into a pouch. Today, thanks to new and improved surgical techniques, most people can avoid a permanent colostomy. In some cases, a temporary ostomy is needed to let the body heal after surgery. Once healing is complete, the bowel can often be reconnected, and normal bathroom habits can resume.
There are two main types of ostomies: colostomy and ileostomy. A colostomy brings part of the colon (large intestine) to the outside of the body. An ileostomy brings part of the ileum (the end of the small intestine) to the outside. Both use a stoma to allow waste to exit into a pouch worn on the outside of the body.
For rectal cancer, a colostomy is placed on the left side of the abdomen, especially when it’s created from the sigmoid colon—the part closest to the rectum. Waste may be soft or firm, depending on how much of the colon was removed and how your bowel worked before surgery. Most people with colostomies continue to eat normally and live full, active lives. They work, travel, play sports, and do everything they did before surgery.
When you have an ostomy, you can’t control your bowel movements. You’ll wear a pouch over your stoma to collect waste. While you're in the hospital, an ostomy nurse will teach you how to care for it. Before you go home, your team will make sure you understand:
While getting an ostomy is a big change, it doesn’t mean giving up your normal life. With support and guidance, most people adjust well and continue to do the things they enjoy.
Learn more tips for living with a colostomy.
Learn more about non-surgical treatment options for rectal cancer.
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