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.

Procedure overview

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 and may include the anal opening in some cases. 

Reasons for the procedure

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:

  • Ulcerative colitis. This causes ulcers and infections to form in the colon. 

  • Crohn's disease. This causes irritation and sores in the colon.

Risks of the procedure

Every surgery has risks. The risks of this surgery include:

  • Bleeding

  • Infection at the skin 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)

  • Sexual problems  

  • 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.

Before the procedure

Before a proctectomy, you will need a complete evaluation by your medical team. This is done to stage your cancer and plan your surgery. This may include special X-rays, blood tests, and an EKG. 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 instructions.

  • You may need to do bowel prep before the procedure. This may include a laxative and enemas to clean out the bowel.

  • You may be told to only drink clear liquids or broth the day before surgery. You may also be told not to have any food or drinks at all up to 12 hours before the procedure.

  • 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.

During the procedure

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 do not 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.

  • Rarely, a surgery known as a pelvic exenteration may be needed. For this, nearby organs are removed, such as the bladder, prostate, or uterus. A colostomy is usually needed after this surgery. 

After the procedure

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 resume an active life. With proper care, the pouch cannot be seen under your clothing, and people will not 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.

  • Gradually resume 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. 

When to call your healthcare provider

Call your healthcare provider if you have any of the below:

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

  • Swelling, redness, bleeding, or fluid leaking from the incision

  • Pain that gets worse

  • Shortness of breath

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