What is a proctectomy?
Proctectomy is a surgery to remove all or part of the rectum. It's commonly used to
treat rectal cancer. The surgery can be done in several ways. The method used depends
on things such as how close the cancer is to the anus and how deeply it has spread.
Your large intestine is made up of your colon and rectum. It's the last part of your
digestive system. The last 6 inches of your large intestine is your rectum. Stool
is stored here until it passes out your anus. Your anus is made of ring-shaped muscles
that hold stool in until you relax them to have a bowel movement. Proctectomy may
remove all or part of the rectum. In some cases it may include removing the anal opening.
Why might I need a proctectomy?
The most common reason for proctectomy is rectal cancer. After you are diagnosed with
rectal cancer, your healthcare team will try to stage it. The stage of your cancer
is how big it is, and how deeply it has spread into and outside of the rectum. Any
stage of rectal cancer may be treated with some type of proctectomy.
Proctectomy may also be used to treat an inflammatory bowel disease. This includes:
Ulcerative colitis. This causes ulcers and infections to form on the inside layer of the colon and rectum.
Crohn's disease. This causes inflammation, irritation, and sores that go deep into the colon wall.
It can happen anywhere along the digestive tract.
What are the risks of a proctectomy?
Every surgery has risks. The risks of this surgery include:
Infection at the cut (incision) site or inside the belly (abdomen)
Blood clots that form in the leg veins and then move to the lungs (pulmonary embolism)
Leaking inside your body at the joined tissues and vessels
Trouble passing urine
Trouble having bowel movements
Wound healing problems or opening of the wound
Scar tissue (adhesions)
Heart or brain injury from anesthesia
There may be other risks, depending on your health. Talk with your healthcare provider
before the procedure if you have concerns.
How do I get ready for a proctectomy?
Before a proctectomy, a complete evaluation will be done by your healthcare team.
This is done to get an idea of your overall health, stage your cancer, and plan your
surgery. It may include imaging tests, blood tests, and an ECG to check your heart.
A colonoscopy may be done to look inside your colon and rectum.
Here's what to expect before surgery:
Your bowels must be empty and cleaned out for the surgery. You'll need to make changes
to your food and drink intake on the days before surgery. Follow all of your healthcare
You may need to do bowel prep. This may include a laxative and enemas to clean out
You may need to take antibiotics before surgery, This is to help reduce your risk
for infection. Sometimes antibiotics are given to you in an IV (intravenous) line.
This is done right before surgery and may also be done during surgery.
You may be asked to stop smoking about 2 weeks before surgery. Smoking delays healing
and recovery. Ask your doctor if you need help stopping.
Tell your healthcare team about all medicines, vitamins, herbs, and supplements you
take. This includes over-the-counter medicines, as well as illegal drugs and marijuana.
You may need to stop taking some medicines in the week before the surgery. This includes
any medicines that thin the blood.
Your healthcare provider may give you other instructions.
What happens during a proctectomy?
You'll be given general anesthesia for the surgery. This is medicine that causes you
to sleep and not feel pain during the procedure.
Here are the different types of surgery that can be done:
Minimally invasive laparoscopic surgery. For this method, the surgeons work through a few small incisions on your belly. A
tube with a tiny camera on the end is used to look at the inside of your body on a
video screen. Special long, thin tools are put into the incisions and used to do the
surgery. Laparoscopic surgery can also be robot-assisted. This is when the surgeon
uses a computer to control robotic arms to do the surgery.
Local resection or transanal excision. These methods are options if the cancer can be reached through the anus and hasn't
spread too deeply. The surgery is done through the anal opening. An incision in the
belly isn't needed.
Low anterior resection (LAR). Cancer that is higher and deeper in the rectum may need an open LAR, which is a different
type of surgery. A larger part of the rectum may need to be removed through an incision
made in the lower belly. This approach lets the surgeon look for signs that the cancer
has spread inside your belly.
Anastomosis. If there's enough healthy rectum tissue left, the ends are reconnected with this
type of surgery. It makes you able to have normal bowel movements through your anus.
But the pattern of your bowel movements will likely change. This includes how often
you go, and how solid your stools are.
Abdominoperineal resection (APR). This may be done if rectal cancer is large and close to the anal opening. For APR,
the rectum is removed and the anal opening is closed. The other end of the colon is
attached to an opening (called a stoma) made on your lower belly. This is called a
colostomy. Bowel movements are then collected in a bag that covers the colostomy.
Pelvic exenteration. This surgery may be needed in rare cases. For this, nearby organs are removed, such
as the bladder, prostate, or uterus. A colostomy is often needed after this surgery.
Even if you don't have a permanent colostomy after proctectomy, a short-term ileostomy
might be needed. This is when the last part of your small intestine is connected to
a hole made on your belly (called a stoma). Stool comes out the stoma instead of moving
through your colon and rectum. This allows your rectum to heal. It also may be done
if you need more treatment after surgery, such as radiation therapy. Later, another
surgery is done to reconnect the intestines and close the ileostomy.
Your surgeon will talk with you about the kind of surgery to be done. Make sure you
know what to expect and how your body will look and work after surgery.
What happens after a proctectomy?
You may need to stay in the hospital for several days after the surgery. You will
have a tube (catheter) in your bladder to drain urine. You may also have surgical
drains. These are used to keep fluid from collecting in the treated area. You'll be
given pain medicine, antibiotics, and a blood thinner to help prevent clots. You may
not be allowed to eat for a few days to give your rectum time to heal. You'll be taught
how to manage your colostomy or ileostomy.
Before you go home, the tubes and drains are often removed. Your pain should be controlled,
and you should be able to eat and drink, but you may have special instructions. You
will be able to walk and take basic care of yourself. But have someone stay with you
for a week or so.
When you go home, follow all the instructions for medicines, pain control, diet, activity,
and wound care.
If you have a colostomy or ileostomy, you may need to work with an ostomy nurse or
enterostomal therapist. Make sure to keep all your follow-up appointments. This specialist
will show you how to use the ostomy pouch, deal with possible side effects such as
skin irritation, and get back to an active life. With the correct care, the pouch
can’t be seen under your clothing. People won’t even know you are wearing it.
Some other common instructions after proctectomy may include:
Get up and walk as much as possible soon after surgery. This is to help you breathe
better and prevent blood clots.
Slowly get back to your normal activities. This may take a few months. Ask your healthcare
providers when you can resume bathing, driving, working, and having sex. Don’t do
heavy lifting for at least 6 weeks.
Watch your wounds for any sign of infection. This may include swelling, redness, bleeding,
or fluid leaking.
Make sure you know what problems to watch for and when you need to call your healthcare
provider. Also be sure you know what number to call to get help after office hours
and on weekends and holidays.
Also be sure you have your follow-up appointments made and know what your next steps
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure