Dr Deepak Varma Gastro Surgeon Cochin

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Surgery for Large Intestine Cancer

Malignant cancer cells form in the tissues of the colon or the large intestine warranting a surgery. As part of the digestive system, the colon is responsible for reabsorbing water and some electrolytes from the digested effluent which reaches the colon from the small intestine. It then helps the residue pass out of the body.

Colon cancer can develop:

  • In individuals who are 50 years and older
  • If there is a family history of colon and rectum cancer
  • Existence or history of colon polyps
  • IBD ulcerative colitis or Crohn s disease
  • Hereditary conditions such as HNPCC and Lynch syndrome

Staging the cancer

One of the most important aspects of colon cancer is staging of the cancer. Treatment options are usually classified by stage.

Colon Cancer Stage

Surgical treatment

Stage 0


simple polypectomy

Local excision

Stage I

Resection and anastomosis

Stage II

Resection and anastomosis along with chemotherapy

Stage III

Resection and anastomosis along with chemotherapy, biologic therapy post surgery and radiation therapy

Stage IV


Resection and anastomosis if symptomatic

Removal of metastasis in liver, ovaries, lungs etc.

Radiation therapy or chemotherapy, if there are symptoms to palliate

Recurrent Colon cancer

Local excision or palliative treatment according to stage

Surgical techniques

Polypectomy / Local Excision:
Local excision is done at early stages of colon cancer or even before cancer develops. A tube (colonoscope/sigmoidoscope) is inserted into the rectum to reach the colon. The polyp is then cut and removed using a snare. The main advantage of this procedure is that it avoids cutting through the abdominal wall. A polyp is considered as the precursor of cancer. This procedure is called a polypectomy.

Colon resection:
A partial colectomy or partial resection of the colon may be conducted if the cancer is large with some healthy tissue still present around it. Healthy parts of the colon are stitched together (a procedure called anastomosis)after removing the part of the colon which is affected by cancer. Lymph nodes near the colon are also removed to be examined for the presence of cancer.

Colostomy is a procedure which brings out part of the large intestine through the abdominal wall. This can be temporary or permanent.

Permanent colostomy is done, if cancer affects the lowest part of the rectum or anal canal, after removal of the disease affected organ.

Temporary colostomy is performed as a part of the removal of mid and low rectal tumours, especially if the patient has received preoperative radiation therapy. This is usually closed after 6 to8 weeks of the first operation.

We are expert in colon and rectal cancer surgeries and has vast experience in laparoscopic surgery for colon and rectum cancers.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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