Types of surgery for colon cancer

The type of surgery you have for cancer of the large bowel (colon) depends on the position and the size of the cancer.

Surgery to the large bowel (colon) is different from surgery to the back passage (rectum).

Types of surgery

There are different types of surgery for colon cancer. The operation that is most suitable for you depends on:

• where your cancer is

• the type and size of your cancer

• whether your cancer has spread to other parts of your body

Types of colon cancer surgery include:  

• surgery to remove a small part of bowel lining - this is called a local resection
• surgery to remove all or part of your bowel - this is called a total or partial colectomy
• having a colostomy or ileostomy
• surgery for a bowel blockage (bowel obstruction)

Surgery to remove a small part of bowel lining (local resection)

This surgery is for small, early stage cancers. Your specialist removes the cancer from the bowel lining, along with a border of healthy tissue (margin). The specialist uses a flexible tube called a colonoscope  to do the operation.

Surgery to remove all or part of your bowel (colectomy)

Your surgeon might remove the part of the colon containing the tumour. This is called a colectomy. How much your surgeon takes away depends on the exact position and size of the cancer.  

The operations have different names depending on where the cancer is. Surgery to remove part of the colon is called a hemicolectomy or partial colectomy. Surgery to remove the whole of the large bowel (colon) is called a total colectomy.

After your surgeon removes your cancer, they join the ends of the bowel back together. This is not always possible during surgery. Your surgeon might then bring part of the bowel out as an opening on your abdomen called a stoma.

Having a stoma

There are two different types of stoma:  

• ileostomy – the cut made in the small bowel is put through the lining of the abdomen  
• colostomy – the cut made in the large bowel is put through the lining of the abdomen

You might have:

• an end stoma – the part of the bowel after the stoma has been removed. This can be temporary or permanent. 
• a defunctioning stoma – the part of the bowel after the stoma is still there. The stoma is usually made to let the bowel rest.

A defunctioning stoma can be temporary and you have another operation to repair the stoma after a few months (a stoma reversal). 

The surgeon might have to make a permanent stoma if:

• there is no bowel beyond the stoma to join the other end to
• they are not able to join the ends of the bowel back together

But most people having a colectomy don't need a permanent stoma. 

Sometimes your surgeon can't tell if you will need a permanent stoma until during the operation. They may not know how big the cancer is, or how much of the bowel it affects. Your surgeon will explain this and how likely it is that you’ll need a permanent stoma to you before the operation. 

Some people find having a stoma easier to manage than any bowel problems they had before surgery. They might choose to have a permanent stoma as part of a shared decision with their healthcare team.

Surgery if cancer blocks the bowel

Sometimes bowel cancer can cause a blockage. This is called bowel obstruction. 

If this happens you will need an emergency procedure straight away. Your surgeon may put a tube called a stent into the bowel. Your surgeon passes the stent through a colonoscope which they gently insert into your back passage (rectum). This holds the bowel open, allowing it to work properly again. Or your surgeon may remove your tumour from the bowel. 

How you have surgery

Open surgery  

This means your surgeon makes one long cut down your abdomen to remove the cancer.  

Keyhole (laparoscopic) surgery  

Your surgeon makes several small cuts in your abdomen. They pass a long tube with a light and camera through one of the holes. Surgical instruments are put into the other holes and are used to remove the cancer.  

Generally, with keyhole surgery, people recover quicker.  

Your surgeon might offer you keyhole surgery if they need to remove part of your bowel. But it depends on your situation, and some people aren’t able to have keyhole surgery. Sometimes the surgeon has to switch from keyhole to open surgery during the operation. Your surgeon will talk to you about this before your operation.  

Robotic surgery  

Some surgeons use a robotic system to help with keyhole surgery. The surgeon sits slightly away from you and can see the operation on a magnified screen. The robotic machine is next to you. The machine has several arms. One arm holds the camera, and the others hold the surgical instruments. The surgeon controls the arms of the machine to remove the cancer. 

Robotic surgery is still quite a new technique and not all hospitals in the UK have this option. Doctors hope that robotic surgery might lower the risk of:

• your surgeon needing to switch to open surgery  

• complications during and after surgery

Jan's story

Jan had surgery to remove bowel cancer in 2021.

"The operation went very well. It was keyhole surgery. I was only in hospital for four days."