Surgical treatment is the main way to fight rectal cancer. In case of bleeding or obstruction, cytoreductive surgery is also performed (removal of the tumor along with part of the rectum). Surgeries also differ in the location of the tumor – there is a low anterior rectal resection and rectal extirpation. The first type of surgical treatment is used if the tumor has formed above the dentate line of the rectum and above the anal canal. The second is if the malignant tumor is located at the level of the dentate line and the anal canal.
Surgical treatment is considered the most effective way to fight rectal cancer. If necessary, in EMC, it can be combined with chemoradiotherapy, depending on the size of the tumor, the presence of metastases and the stage of cancer.
There are three types of surgery to remove tumors that are localized in the rectum. They are classified depending on the method of execution – there are laparoscopic, robotic and open methods. The first two methods are considered the most modern for fighting rectal cancer, as they do not require large incisions. In the process of removing malignant tumors, the patient loses significantly less blood than with the open method, which means that the rehabilitation time after removal of the rectum is reduced. The choice of surgery depends on the presence of concomitant pathologies in the patient. The final decision on the method of tumor removal is made by an interdisciplinary council of doctors individually for each EMC patient.
A robotic operation involves the removal of a tumor using a high-tech Da Vinci robot operated by a surgeon. The robot is equipped with miniature instruments and high-resolution optics, which also improves the quality of operations.
At the end of the operation, the patient is fitted with a stoma, which is a special opening in the abdominal wall to drain feces. There is an ileostomy (connects the lumen of the lower part of the small intestine to the surface of the skin) and a colostomy (connects the lumen of the large intestine to the surface of the skin).
Often the tumor of the rectum is located too low, very close to the anal canal. In many clinics, in this case, surgeons perform an extirpation of the rectum and remove a colostomy or ileostomy into the intestine (on the anterior abdominal wall). In the EMC, in most cases, protective ileostomes are not used.: This is important for the anastomosis (the junction of the two segments of the rectum after removal of the affected area) to heal completely. This approach reduces the risk of bleeding after removal of the rectum and the risk of peritonitis.
After the intestine and tumor have been removed, the patient is not fed in the early postoperative period, but water is given to him and parenteral administration of nutrients into the body is prescribed through injections: thus, the patient receives the necessary proteins, fats and carbohydrates, but the intestinal contents do not enter the site of the anastomosis and allows it to heal without additional risks..
During surgical treatment, it is important to isolate the hypogastric plexus layer and, during resection of the tumor and part of the colon, not to harm the nerve endings. EMC specialists have extensive experience in performing such nerve-saving surgical procedures. Surgeons have a Harmonic ultrasonic scalpel in their arsenal, which allows them to very subtly isolate tissue structures without damaging them, as well as other modern devices. This approach avoids complications in the early postoperative period (urinary disorders, erectile dysfunction, pelvic organ dysfunction).
Before performing surgery for rectal cancer, specialists carry out a thorough diagnosis: this will avoid complications in the future. One of the main advantages of the EMC is the opportunity to undergo a comprehensive preoperative examination. These studies usually require hospitalization, but in the EMC, every patient can undergo them on an outpatient basis. Preoperative examination before removal of the rectum involves examinations by an anesthesiologist, cardiologist and therapist. It also includes electrocardiogram (ECG), ultrasound examination of the heart and blood vessels of the lower extremities, blood analysis, computed tomography (CT) of the chest organs. At the EMC, the patient enters the clinic on the day of rectal resection, but if desired, he can arrive the day before so that specialists can help him carry out intestinal cleansing procedures.
Immediately after surgery to remove rectal cancer, the patient is transferred to the intensive care unit for observation during the day. The patient is regularly examined by specialists – they monitor blood pressure, pulse, and conduct cardiological examinations. If the patient's condition is stable, he is transferred to the hospital the next day after the removal of the rectum. Here, a physiotherapist and a rehabilitologist begin to work with the patient, who help him take the first steps, stand up straight and move around the ward on his own.
The duration of rehabilitation depends on the type of treatment. As a rule, after open operations, the patient is discharged a week after surgery, and after laparoscopic and robotic operations, 4-5 days later. The EMC has created all the conditions for the recovery process to take place in the fastest and most comfortable way. For this purpose, there is a rehabilitation center in Zhukovka, where specialists of various categories help patients return to their usual lives after surgical treatment.
Advantages of EMC rehabilitation
There are absolute and relative contraindications to surgical treatment for rectal cancer. Surgical intervention is impossible with an advanced oncological process, when metastases have formed in distant organs. If we talk about relative contraindications to the removal of the rectum, then these may be pronounced concomitant diseases of the cardiovascular system, kidneys, and lungs. In this case, it is first necessary to stabilize the patient's condition and reduce the risk of postoperative complications after removal of the rectum. Then, an interdisciplinary consultation of doctors of different categories (surgeons, oncologists, cardiologists and other specialists) decides on the surgical treatment individually for each patient.
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