Rectal Cancer Surgery
Located deep in the pelvis and close to other important organs and nerve tracts, rectal surgery is an operation much more difficult than colon surgery and requires a very experienced surgeon. Often a neoadjuvant (pre-operative) therapy is given before surgery if the tumor is very large and/or close to the anus. The neoadjuvant therapy consists of either a short-termed radiation or a combined chemo-radiation in order to shrink the tumor or to lower the risk of recurrence. If the sphincter still must be removed, the surgeon will perform a permanent ostomy (colostomy). Chemotherapy can also be given after surgery (adjuvant therapy) in order to enhance chances for healing.
The most commonly performed surgical technique today is the total mesorectal excision (TME). Through an abdominal incision the complete rectum is removed, including the mesorectum, an area of fatty tissue below the rectum containing lymph nodes. A short portion of the rectum near the anus is reattached to the remaining portion of the colon, this is called an anastomosis. Often a short-term (about 3 months) ostomy may be done in order to let the colon heal. Once the colon has healed, the ostomy can be reversed.
In case the tumor is located too close to the anus, it may be necessary to remove the sphincter and make a permanent ostomy. The necessity of this also depends on the skills of the surgeon, thus the choice of a specialized hospital and an experienced surgeon is a decisive factor.
Situation after surgery
The ability to control the urge to have bowel movement and intestinal gas is called continence. The sphincter, which is essential for continence, is controlled by a very complicated meshwork of nerves and muscles. After rectal surgery, this function often is disordered, especially if the surgical area lies close to the sphincter. Even at an older age the human body is able to adjust to this, so that, in most cases, incontinence can be improved over time, making a permanent ostomy unnecessary.
In some cases the sphincter must be completely removed, and an ostomy is necessary. Generally, most patients will adjust very well to the new situation after a phase of familiarization. Patients with an ostomy may attend courses taught by trained nurses or ostomy therapists during their hospital visit, or they may seek advice and support in self-help groups (www.ilco.de and Deutsche Kontinenzgesellschaft e.V.). Today, nearly every profession can be pursued and every sport can be practiced with an ostomy.