Surgical Precision Colorectal Cancers Get the Minimally Invasive Treatment

About 112,000 people are diagnosed with colon cancer each year, in addition to 41,000 new cases of rectal cancer. Together, the conditions kill about 50,000 Americans annually.

But not only are advances in technology bringing those numbers down, they’re sending patients home from colon and rectal surgery faster and healthier than ever before.

“We’re noticing more of an effort to do these surgical procedures through a minimally invasive approach, due to several major studies confirming that laparoscopic surgery is just as effective as open surgery,” said Dr. Richard Arenas, chief of Surgical Oncology at Baystate Medical Center. “There don’t seem to be any limitations, and it does provide patients the benefit of a shorter recovery time, and getting back to work more quickly.”

Laparoscopic surgery replaces the one large incision of traditional open surgery with a series of much smaller cuts; the surgery itself is aided by a tiny camera. It’s an especially beneficial mechanism to treat colorectal surgeries, which tend to befall an older, frailer population than average.

There are several benefits to that, particularly for older patients, said Dr. Francis Martinez, a general surgeon at Holyoke Medical Center specializing in colon and rectal surgery. “It makes your stay in the hospital shorter and lessens the amount of pain you have. In all, your recovery period will be much shorter, compared to an open surgery.”

“The older population seems to be best-suited to benefit from laparoscopic surgery,” Arenas agreed. “A young person might do well by either method, but if you look at how long it takes to get back on their feet, the older patient will have much less stress after laparoscopic surgery than an open surgery.”

However, he was quick to add, “it may not be possible to perform every surgery laparoscopically, depending on how big the tumor is and its location on the colon. But almost everyone can now at least be evaluated for a laparoscopic colon resection.”

Hard Cell

Most cases of colon cancer begin as small, benign clumps of cells called adenomatous polyps; over time, some of these can become colon cancers. Polyps may be small and produce few, if any, symptoms, but regular screening tests can help prevent colon cancer by identifying polyps before they become cancerous.

“It’s very treatable if we diagnose it early,” Martinez said. “The main treatment is surgery, and many times we can do it laparoscopically; instead of making one big incision, we can make three, four, five small incisions. But not everyone can have that option; depending on what stage cancer you have and how many surgeries you’ve had in the past, it can be difficult to do it laparoscopically.”

During surgery for colon cancer, the surgeon will typically remove the part of the colon that contains the cancer, along with a margin of normal tissue on either side of the cancer to ensure that no cancer is left behind. Nearby lymph nodes are usually also removed and tested for cancer.

The surgeon is often able to reconnect the healthy portions of the colon or rectum, but when that’s not possible, the patient may need to have a permanent or temporary colostomy, which involves creating an opening in the wall of your abdomen from a portion of the remaining bowel for the elimination of body waste into a special bag. Sometimes the colostomy is only temporary, allowing the colon or rectum time to heal after surgery. In some cases, however, the colostomy may be permanent.

Because of advances in chemotherapy and radiation, Arenas said, doctors will often prescribe them before rectal cancer, unlike other procedures, when those therapies typically follow the surgery. Staving off the need for a colostomy is one reason; if a surgeon can shrink the tumor down sufficiently, he might be able to perform a “sphincter-preserving” surgery, one that doesn’t require such wide margins, and allow the patient to keep his normal bowel functions intact.

Still, side effects of colon cancer surgery may include short-term pain and tenderness, as well as temporary constipation or diarrhea. Patients with a colostomy may also develop an irritation on the skin around the opening.

Halting the Spread

Laparoscopic technology was first used for gallbladder surgeries, but it has proven useful for a wide range of procedures, including gastric bypass and, of course, colorectal procedures, Arenas said.

“We’ve been doing laparoscopic colon surgeries for more than five years, but there was always this concern about getting a wide-enough margin. No one knew exactly what the benefits of doing laparoscopic versus open surgery were. But only through validation in some large, comparative trials have we now established that it’s perfectly safe to do laparoscopic colon surgery for cancer.”

Other advances are equally exciting, he said. For example, in the past, when colon cancer had spread to the liver and metastasized — what’s known as a stage IV cancer, the most serious stage — a patient often didn’t have much time to live.

However, “there are some new types of chemotherapy agents and some new biologic therapies, new drugs that attack the tumors in the liver,” Arenas said. “We have seen some dramatic responses by patients who would generally have a poor outlook of survival.”

Specifically, he said, these agents are doing a better job controlling the disease and even regressing the tumor, giving surgeons an opportunity to go in surgically and remove the tumor, where that would have been impossible before.

In addition, if the diseased area is not treatable by cutting, it’s now possible to ‘burn’ the tumors with a microwave field to destroy or at least shrink them. “The end result of this is that a patient who has stage IV colon cancer that has metastasized to the liver may not be cured, but still may live many years,” Arenas said. “This, despite the fact that the same diagnosis, in the past would have offered them a survival of less than a year, maybe two.”

Minimally invasive, it turns out, can lead to maximum life — or at least closer than ever before.