What is a proctectomy?
Proctectomy is a surgery to remove all or part of the rectum. It is often needed to
treat rectal cancer. If you have rectal cancer, your treatment will depend on where
the cancer is and how much it has grown, as well as other factors. For most people
with rectal cancer, a proctectomy will be needed. It may also be used to treat an
inflammatory bowel disease.
Proctectomy can be done in several ways. The type will depend on factors such as where
your cancer is growing and how deeply it has spread. Your large intestine, which is
made up of your colon and rectum, is the last part of your digestive system. The last
6 inches of your large intestine are your rectum and anal area. Proctectomy may remove
all or part of the rectum. In some cases it may include 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 deeply it has spread into and outside of the rectum. All stages of rectal cancers
may be treated with some type of proctectomy.
Proctectomy may also be used to treat an inflammatory bowel disease. This includes:
What are the risks of a proctectomy?
Every surgery has risks. The risks of this surgery include:
Infection at the skin cut (incision) site or inside the stomach
Blood clots that form in the leg veins and then move to the lungs (pulmonary embolism)
Leaking through the joined tissues and vessels
Trouble passing urine
Trouble having bowel movements
Slower wound healing, opening of the wound, or 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, you will need a complete evaluation by your healthcare team.
This is done to stage your cancer and plan your surgery. This may include special
X-rays, blood tests, and an ECG. You may have a colonoscopy. This is a procedure to
look inside your colon and rectum. It is done with a flexible, lighted scope and a
tiny video camera.
Here is what to expect before surgery:
Your bowels must be empty for the surgery. You will need to make changes to your food
and drink intake on the days before surgery. Follow all of your healthcare team’s
You may need to do bowel prep before the procedure. This may include a laxative and
enemas to clean out the bowel.
Follow any directions you are given for not eating or drinking before surgery. .
Tell your healthcare team about all medicines, vitamins, and supplements you take.
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?
Here is what to expect during the surgery:
You will have general anesthesia for the surgery. This is medicine that causes you
to sleep during the procedure.
A method called minimally invasive laparoscopic surgery may be used during some types
of proctectomy. With this procedure, the surgeons work through several small incisions
with special tools while watching the procedure on a video screen.
You may have local resection or transanal excision. These are done for cancer that
can be reached through the anal opening and have not spread too deeply. These methods
don’t need an incision in the belly.
Cancer that is higher and deeper in the rectum may need a different type of method.
A larger section of the rectum may need to be removed through an incision in the lower
belly. This is called a low anterior resection (LAR).
If there is enough healthy rectum tissue left, they are then reconnected. This is
called anastomosis. You will be able to have normal bowel movements through the anus.
The pattern of your bowel movements will likely change after the procedure. This includes
how often you go, and how loose your stools are.
If rectal cancer is large and close to the anal opening, you may have an abdominoperineal
resection (APR). For APR, the rectum is removed and the anal opening is closed. The
other end of the colon is attached to an opening (stoma) on the outside of the lower
belly. This is called a colostomy. Bowel movements are then collected in a bag attached
to the colostomy.
In rare cases, a surgery called a pelvic exenteration may be needed. For this, nearby
organs are removed, such as the bladder, prostate, or uterus. A colostomy is often
needed after this surgery.
What happens after a proctectomy?
You may need to stay in the hospital for several days after the surgery. When you
go home, make sure to follow all instructions for medicines, pain control, diet, activity,
and wound care.
If you have a colostomy after surgery, you may need to work with an ostomy nurse or
enterostomal therapist. Make sure to keep all your follow-up appointments. He or she
will show you how to use the ostomy pouch, deal with side effects such as skin irritation,
and get back to an active life. With 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.
Slowly get back to your normal activities. This may take a few weeks. Ask your healthcare
providers when you can resume bathing, driving, working, and sexual activity. Don’t
do heavy lifting for 6 weeks.
Watch your wounds for any sign of infection. This may include swelling, redness, bleeding,
or fluid leaking.
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