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Minimally invasive surgery (MIS) for the management of colon and rectal cancer

Minimally invasive surgery

Many traditional open surgeries for cancer management can now be performed using a laparoscope for a minimally invasive approach. For patients, this means that they have almost no incision and much faster recovery time. The goal is to treat the cancer with the same aggressive approach but to do this in a way that gets patients back to their lives as quickly as possible.

This minimally invasive approach has proven benefits both short term as well as the long term recovery. In the short term, large international trials have shown that this approach is equivalent from a cancer perspective but the lack of a large incisions decreases pain, decreases narcotic use, shortens length of stay in hospital, hastens full recovery and many other benefits. In the long term, the benefits are profound, in that there is no residual scar tissue in the abdomen and therefore bowel blockages from scar tissue decreases significantly. Also, without a residual large scar, hernias and wound complications do not occur.

This approach has been studied extensively for many years in the setting of both colon and rectal cancer and is known to be safe and effective.

The two patients below required surgery to remove cancer from their colons. The patient on the left had a laparoscopic procedure, while the patient on the right went through a traditional, open surgery.

Minimally invasive surgery incision

Laparoscopic
(Minimally Invasive)
Surgery Incision

Open surgery incision

Open Surgery Incision

On average, based on large studies, the patient on the left will:

  • get home two days earlier from hospital
  • be back to work up to three weeks earlier
  • have much less pain and use less pain medication
  • have a quicker return of bowel function
  • much less likely to develop a hernia through the abdominal wall
  • much less likely to have a scar tissue left behind in the abdomen

Although laparoscopic surgery is not appropriate for all cancer management, many more cancers are safely and effectively being treated with this technique. Is a minimally invasive surgery right for you? Ask your doctor. Or ask one of ours.

Below, our surgeons have answered a few questions that are often asked about laparoscopic surgery for the management of colorectal cancers.

How does laparoscopic surgery work?

Laparoscopic surgery employs very small instruments along with a long thin video camera called a laparoscope.

The procedure involves a few tiny incisions with ports placed through the incisions. Using the laparoscope as a visual guide, the surgeon maneuvers the long, thin surgical instruments while looking at the monitors to completely remove the tumour.

What are the benefits of laparoscopic surgery?

Generally, patients have less blood loss during surgery, have a shorter stay in hospital, and have a shorter recovery time at home after the procedure.

What are the drawbacks of laparoscopic surgery?

If used for appropriately selected cases by trained high volume surgeons, there are no documented drawbacks. If used inappropriately, the drawbacks will be similar to any other surgery that does not adhere to appropriate cancer removal principals.

Does this surgery still get all the cancer, even though it is minimally invasive?

Removing all the cancer is far more important than whether the operation is done open or laparoscopically. As such we ONLY offer minimally invasive surgery when we are certain we are removing all the cancer exactly as we would open. If at any point this becomes more difficult or there are unexpected findings, than we convert the operation from laparoscopic to open and complete the surgery open.

I met with a colorectal cancer surgeon at another hospital who did not mention the option of laparoscopic surgery. Does that mean I’m not eligible?

While we can’t speculate on cases without meeting you in person, it is entirely possible that your type of cancer cannot be removed laparoscopically. However, it is essential that a laparoscopic approach be considered. Not all surgeons treat colon and rectal cancer laparoscopically and it is possible that another look at your case could tell us that the minimally invasive approach is not only possible, but preferred. If you’d like to have a Sunnybrook colorectal cancer surgeon assess your case specifically, you can email us directly.

Types of minimally invasive colorectal cancer procedures

Laparoscopic right hemicolectomy

The right side of the colon (approx 1/3 of colon) is removed and the end of the small intestine is connected to the transverse colon.

Laparoscopic left hemicolectomy

The left side of the colon (approx 1/4 of colon) is removed and the transverse colon is reattached to the sigmoid colon.

Laparoscopic sigmoid colectomy

The sigmoid colon is removed and the descending colon is reattached to the upper rectum.

Laparoscopic low anterior resection

The majority of the rectum is removed at least 1-2 centimetres past the cancer and the colon is brought down into the pelvis to replace the removed portion of rectum. The colon is reattached to lower remaining rectum.

Laparoscopic abdominal perineal resection

The entire rectum and anus must be removed when the cancer involves the anal sphincter muscle. The end of the colon is brought out of abdominal wall and made into a permanent colostomy (pouch).

Laparoscopic multivisceral resection

The colon or rectum and other organs that the cancer has invaded are all removed in order to ensure the cancer is completely gone. In such a situation the reconstruction depends on the extent of what was necessary to remove in order to clear the cancer.

TAMIS

Transanal minimally invasive surgery. Small rectal lesions are laparoscopically removed through the anus with no scars at all.

TaTME

Transanal total mesorectal excision means the rectum is removed through the anus and the colon is brought down and reattached to the remaining rectum or anus.

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