Make your next step an informed one. No doubt you have lots of questions about colorectal surgery. Here’s some information to help begin answering them:
A. Your diagnosing physician will refer you to a surgeon. But how will you know if she/he is right for you?
Simple – ASK QUESTIONS.
When you meet with the surgeon, explore the following topics:
In addition, you can call your insurance company to ask about that surgeon's quality rating and whether they have the best coverage from your plan. You can also look up the surgeon’s qualifications online and see what other patients have to say.
As for a second opinion, you should always consider requesting one. After all, this is a big decision. And like all big decisions, it’s wise to explore your options and gather information. Don’t worry, you won’t offend your doctor. It’s common medical practice to get other expert opinions.
If you aren't sure who else could perform surgery, you can call your diagnosing physician to ask for another recommendation. You can also check with your insurance provider for a surgeon or hospital that has high quality ratings.
Check out the hospital options in your area. Some hospitals specialize in colorectal surgery or cancer care, while others do not. You can ask your diagnosing physician for their opinion of the best hospital options in your local area or within the state. Depending on the complexity or stage of your disease, it may make sense to travel to another area to be treated at a hospital that specializes in colorectal surgery.
What do you do if you get differing opinions? Then consider the pros and cons of each, along with the surgeon’s experience. Ask yourself which surgeon and approach gives you the most confidence and comfort. There are many surgeons who can perform colon and rectal surgery. You deserve the one who is right for you.
A. All surgery, whether traditional or minimally invasive, has risks. However, minimally invasive surgery (MIS) offers many benefits over open surgery. With MIS you get a smaller scar and1:
No wonder more and more MIS procedures are performed every year. However, sometimes open surgery is the preferred procedure. Certain factors, such as previous abdominal surgery, obesity, and other medical conditions may mean open surgery is a better approach. Your doctor will help you make sense of your options.
A. The bag, or pouch, worn outside the body to collect waste is often only need for a short time — a few months — while the intestine heal.2 However, sometimes a disease or problem necessitates the bag for rest of a person’s life. Less than 10% of colon cancer patients have permanent ostomies.3
Be sure to talk to your surgeon about what is your likelihood of needing a bag, whether it is likely to be temporary or permanent, and what would be the timing to reverse it. Your doctor has resources to help you learn about quality of life with an ostomy.
A. Specific post-surgery practices vary by patient. However, in general, most patients are encouraged to eat, drink, and move around the first day after surgery.
Eating and drinking: A low-fiber diet is recommended for the first few weeks to reduce the amount and frequency of bowel movements. This facilitates intestinal healing. In addition, drinking 8-10 glasses of fluid each day is recommended.4
Pain control: Your doctor will prescribe pain medication after surgery. The amount of pain experienced depends on the procedure and your pre-existing health factors. Medications such as ibuprofen are used to treat mild pain/inflammation and may be combined with narcotics to treat severe pain.4
Mobility: Your care team will recommend gentle activities, such as short walks in the hospital hallway or exercises that can be done in bed, or in a chair. Moving early after surgery can help avoid problems such as blood clots, chest infections, and breathing issues.4
Bowel movement: Expect your bowel movements to be more frequent and looser than usual for the first two weeks after surgery. Avoid straining.4 If you have an ostomy, your care team will show you how to care for it, including changing the bag.
A. That depends on the type of procedure and how well you recover. The average hospital stay after open surgery is 9 days. Laparoscopic surgery typically results in an earlier release — 2.5 days on average. Average recovery after open surgery is 6 weeks, and 1-2 weeks for laparoscopic.5-20 Your surgeon will explain the details of your hospital stay and recovery after surgery depending on your specific case.
As you recover from colorectal surgery, you may only need over-the-counter pain relievers such as acetaminophen, ibuprofen or naproxen. On the other hand, managing significant pain may require prescription opioid medications.
Opioids are a class of drugs that include the illegal drug, heroin. Opioids also include prescription pain medications such as oxycodone, hydrocodone, tramadol, codeine, and morphine. All opioids — illicit and prescription — come with the risk of addiction.21 The statistics are alarming:
The opioid addiction crisis is real. Each year, it affects millions of Americans — your neighbors, coworkers, friends, family, and community.25 So what can you do to avoid becoming “another statistic”?
That’s right. Minimally invasive surgery (MIS) may reduce your chance of opioid misuse and dependence following surgery.26 When compared to open surgery, studies show that patients who undergo MIS have less pain, shorter hospital stays and are less likely to require opioids beyond 30 days.1,26 So when you meet with your doctor prior to surgery, ask if MIS is an option for you. During this pre-op appointment, also be sure to talk about all the medicines and supplements you already take and how much alcohol you drink. This will help ensure that you are taking any pain medicine safely.
Tiwari MM, Reynoso JF, High R, Tsang AW, Oleynikov D. Safety, efficacy, and cost-effectiveness of common laparoscopic procedures. Surge Endosc. 2011;25(4):1127-1135.
American Cancer Society. “What is a colostomy?” www.cancer.org. Published 2019. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/colostomy/what-is-colostomy.html Accessed April 5, 2022
Colorectal Cancer Alliance. “There are many treatment options: Ostomy.” https://www.ccalliance.org/colorectal-cancer-information/treatments/ostomy Accessed April 5, 2022
American College of Surgeons. Surgical Patient Education. “Colectomy: Surgical Removal of the Colon.” ACS. https://www.facs.org/-/media/files/education/patient-ed/colectomy.ashx Accessed April 5, 2022.
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Webmaster. Laparoscopic colon resection surgery patient information from SAGES. SAGES. https://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-colon-resection-from-sages/. Updated March 1, 2015. Accessed Jan. 10, 2017.
Fitch K, Engel T, Bochner A. Cost differences between open minimally invasive surgery. Manag Care. 2015;24(9):40-48.
Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477-484.
Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N. Is minimally invasive colon resection better than traditional approaches?: First comprehensive national examination with propensity score matching. JAMA Surg. 2014;149(2):177-184.
Orcutt ST, Marshall CL, Robinson CN, et al. Minimally invasive surgery in colon cancer patients leads to improved short-term outcomes and excellent oncologic results. Am J Surg. 2011;202(5):528-531.
Steele SR, Brown TA, Rush RM, Martin MJ. Laparoscopic vs. open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg. 2008;12(3):583-591.
Odermatt M, Miskovic D, Siddiqi N, Khan J, Parvaiz A. Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study. World J Surg. 2013;37(10):2458-2467.
Prakash K, Varma D, Rajan M, et al. Laparoscopic colonic resection for rectosigmoid colonic tumours: a retrospective analysis and comparison with open resection. Indian J Surg. 2010;72(4):318-322.
Chen K, Zhang Z, Zuo Y, Ren S. Comparison of the clinical outcomes of laparoscopic-assisted versus open surgery for colorectal cancer. Oncol Lett. 2014;7(4):1213-1218.
Hardy KM, Kwong J, Pitzul KB, et al. A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution. Surg Endosc. 2014;28(4):1213-1222.
Thompson BS, Coory MD, Gordon LG, Lumley JW. Cost savings for elective laparoscopic resection compared with open resection for colorectal cancer in a region of high uptake. Surg Endosc. 2014;28(5):1515-1521.
Marshall CL, Chen GJ, Robinson CN, et al. Establishment of a minimally invasive surgery program leads to decreased inpatient cost of care in veterans with colon cancer. Am J Surg. 2010;200(5):632-635.
da Luz Moreira A, Kiran RP, Kirat HT, et al. Laparoscopic versus open colectomy for patients with American Society of Anesthesiology (ASA) classifications 3 and 4: the minimally invasive approach is associated with significantly quicker recovery and reduced costs. Surg Endosc. 2010;24(6):1280-1286.
Day AR, Smith RV, Jourdan IC, Rockall TA. Survival following laparoscopic and open colorectal surgery. Surg Endosc. 2013;27(7):2415-2421.
Kapritsou M, Korkolis DP, Konstantinou EA. Open or laparoscopic surgery for colorectal cancer: a retrospective comparative study. Gastroenterol Nurs. 2013;36(1):37-41.
Agarwal S, Gincherman M, Birnbaum E, Fleshman JW, Mutch M. Comparison of long-term follow up of laparoscopic versus open colectomy for transverse colon cancer. Proc (Bayl Univ Med Cent). 2015;28(3):296-299.
National Institute on Drug Abuse. “Opioid Overdose Crisis.” National Institute on Drug Abuse, 2021, nida.nih.gov/drug-topics/opioids/opioid-overdose-crisis. Accessed April 1, 2022.
Overton HN, Hanna MN, Bruhn WE, et al. Opioid-Prescribing Guidelines for Common Surgical Procedures: An Expert Panel Consensus. J AM Coll Surg. 2018;227(4):411-418. doi:10.1016/j.jamcollsurg.2018.07.659.
Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse; Phillips JK, Ford MA, Bonnie RJ, editors. Published by National Academies Press (US); 2017 Jul 13.
CDC Guideline for prescribing opioids for chronic pain. Center for Disease Control and Prevention Website: www.cdc.gov/drugoverdose/prescribing/guideline.html Published 2019. Accessed March 24, 2020.
Key Substance Use and Mental Health Indicators in the United States: Results form the 2018 National Survey on Drug Use and Health. Published by the Substance Abuse and Mental Health Services Administration. Health & Human Services Publication No. PEP19-50682019U.S.
Stafford C, Francone T, Roberts PL, Ricciardi R. What factors are associated with increased risk for prolonged postoperative opioid usage after colorectal surgery? Surg Endosc. 2018;32(8):3557–3561.