Advances in Colon and Rectal Cancer Surgery

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Treatment for colorectal cancer, the third most common cancer diagnosed in the United States, usually involves surgery to remove tumors, which sometimes leads to complications and long recovery times. One recent innovation in surgical treatment focuses on improving results by enhancing the care patients get before, during, and after their operation.

An image of colon cancer, with cancer cells forming circled structures.

Called “enhanced recovery after surgery,” or ERAS, it’s a method that has decreased the rate of complications and has shortened hospital stays for patients.

“No matter how you do the surgery itself, everybody does much better,” explains Ronald Bleday, MD, a colorectal surgeon at Dana-Farber’s Colon and Rectal Cancer Center.

Prior to surgery, patients take liquid preparations that cleanse the bowels, and also ingest carbohydrate-rich drinks that hydrate the body, stimulate insulin production, and reduce stress hormones. This prevents the body from going into “starvation metabolism” on the day of surgery, Bleday explains.

Patients are also given less intravenous fluids than what was standard previously, he says, to avoid over-hydration.

ERAS was originally developed in Sweden and Denmark, and is now being adopted throughout the Partners HealthCare system, Bleday says.

Another component of ERAS is pain control that emphasizes reducing the amount of narcotic medications. In place of narcotics, patients receive nerve block injections and intravenous non-narcotic medications. The result: less delirium, nausea, and gastroparesis – failure of the stomach to empty normally.

In the two years since patients have been supported with ERAS, Bleday reports: “We’ve reduced the average length of stay from five to three days, lowered infection rates from 12 percent to 2.5 percent, and reduced heart arrhythmia complications from 5.5 percent to 1.5 percent – all without any increase in re-admissions or kidney problems.”

As for performing the surgeries, most colon cancer operations are done laparoscopically or robotically using instruments working through small incisions, unless the surgeons encounter problems that can be handled better by making a standard large “open” incision. These new approaches are more applicable for colon cancers as opposed to rectal cancers, where the efficacy of minimally invasive surgery is still be investigated.

Bleday and his colleagues are also evaluating a minimally invasive transanal approaches to rectal cancer surgery: Instead of making an incision in the abdomen, surgeons remove small cancers by inserting instruments into the anus and rectum, in some cases after treating the patient with radiation to shrink the tumor.

Learn more about colon and rectal cancer treatment at Dana-Farber.

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