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Proctectomy

Proctectomy

Proctectomy is a surgical operation to remove all or part of the rectum. It is often needed to treat rectal cancer. If you have been diagnosed with rectal cancer, your treatment will depend on where and how far along your cancer is, as well as other factors. But for most people with rectal cancer, some type of proctectomy procedure will be needed. A proctectomy may also be used to treat inflammatory bowel disease.

Procedure overview

Proctectomy can be done in several ways. The type that you and your surgeon choose will depend on factors such as the location of your cancer and how deeply it has spread. Your large intestine, which is made up of your colon and rectum, is the last part of your digestive system. The last 6 inches of your large intestine are your rectum and anal area. Proctectomy may remove all or part of the rectum and may include the anal opening in some cases. 

Reasons for the procedure

The most common reason for proctectomy is rectal cancer. After your healthcare providers have diagnosed rectal cancer, they will try to find out how advanced your cancer is by staging it. The stage of your cancer is determined by how deeply it has spread into the rectum. Also, whether it has spread outside of the rectum. All rectal cancers—stages I though IV—may be treated with some type of proctectomy.

Ulcerative colitis may also be treated with proctectomy. Ulcerative colitis causes ulcers and infections to develop in the colon. In some people with ulcerative colitis, colon surgery is needed. This surgery may include proctectomy. People with Crohn's disease, another type of inflammatory bowel disease, may undergo a proctectomy as well.

Risks of the procedure

Proctectomy is a major surgery that is usually done under general anesthesia during which you are put to sleep. Any general anesthesia includes a small risk for heart or brain injury.

Other risks of proctectomy include:

  • Bleeding

  • Infection at the skin incision site or inside the stomach

  • Pulmonary embolism (blood clots that can form in the leg veins during or after surgery and then move to the lungs) 

  • Leaking through the surgically joined tissues and vessels

  • Trouble passing urine

  • Trouble passing bowel movements

  • Delayed wound healing, opening of the wound or scar tissue (adhesions)

  • Sexual problems  

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

Before the procedure

Before proctectomy you will need a complete evaluation by your medical team to stage your cancer and plan your surgery. This may include special X-rays, blood tests, and a procedure called a colonoscopy to look inside your colon and rectum with a flexible, lighted scope and a tiny camera that sends video images.

Other steps before surgery:

  • Tell your healthcare provider about any medicines you are taking, including any over-the-counter drugs and any blood-thinning medicine, including aspirin or anti-inflammatory medicines.

  • If you are still smoking, ask your healthcare provider how soon before surgery you need to quit.

  • Special instructions before proctectomy may include stopping certain medicines, or taking antibiotics.

  • Cleaning out your colon and rectum before surgery, a procedure called bowel prep, is a crucial part of preparation. This will include limiting your diet to clear liquids, taking medicines that make you move your bowels, and having nothing to eat or drink the night before surgery. Follow your surgeon's bowel prep instructions carefully.

During the procedure

Here is what to expect during the surgery:

  • Cancers that can be reached through the anal opening and that have not spread too deeply may be removed by a surgical procedure called local excision or transanal resection. These approaches do not need an incision in the stomach.

  • Cancers that are higher and deeper in the rectum may need to be removed by taking a larger section of the rectum out through an incision that goes through the lower stomach. This is called a low anterior resection (LAR).

  • If rectal cancer has not spread and there is enough tissue on either side of the cancer, the ends of the nondiseased intestinal tissues can be reconnected. This is called anastomosis. After proctectomy with anastomosis, a person can have normal bowel movements through the anus. The pattern of bowel movements (frequency or looseness) often changes after the procedure.

  • If rectal cancer is too large and close to the anal opening, it may not be possible to spare the rectal area. In these cases a procedure called abdominoperineal resection (APR) may be needed. In APR surgery, the rectum is removed, the anal opening is closed, and the other end of the colon is attached to an opening (stoma) on the outside of the lower stomach. This is called a colostomy. Bowel movements are collected in a special bag attached to the colostomy.

  • Rarely, a more extensive operation known as a pelvic exenteration might be needed, in which nearby organs, such as the bladder, prostate, or uterus, are removed. A colostomy is usually needed after this operation. 

  • A technique called minimally invasive laparoscopic surgery may be used during some types of proctectomy. With this procedure, the surgeons operate through several small incisions with special instruments while watching the procedure on a television monitor.

After the procedure

Depending on the type of operation, you may need to stay in the hospital for several days after the operation. Once your healthcare providers feel you have recovered enough to go home, it will be important to follow all your instructions for medicines, pain control, diet, activity, and wound care.

If you have a colostomy after proctectomy, you may need to work with specially trained ostomy nurses or enterostomal therapists. Make sure to keep all your follow-up appointments. He or she will show you how to use the ostomy pouch, deal with side effects such as skin irritation, and resume a full, active life. With proper care, the pouch cannot be seen under your clothing, and people will not even know you are wearing it.

Some other common instructions after proctectomy may include:

  • Be up and walking as much as possible soon after surgery.

  • Gradually resume normal activities; this may take a few weeks. Ask your healthcare providers when you can resume bathing, driving, working, and sexual activity. Heavy lifting is generally restricted for 6 weeks after stomach surgery. 

  • Watch your wounds for any sign of swelling, redness, bleeding, or discharge.

  • Let your healthcare provider know about any increasing pain, chills or fever, or shortness of breath. 

 

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