Laparoscopic colorectal cancer surgery

• significantly less pain
• quicker return of bowel functions
• decreased blood loss
• quicker and easier mobilization
• less chance of wound infection
• less chance of abdominal wall hernia
• shorter hospital stay
• smaller scars, better cosmetics

In preparation for surgery, a prehabilitation program should bring patients in the best possible condition.  As part of it, psychological support from the surgeon has an important role. Patients should be well aware of what and why and how will happen, so they can make a well backed, informed decision.

Nutrition: healthy, nutrious food rich in protein, energy, vitamins should be consumed - tailored to patient’s needs eg, diabetes, obesity. Proportionate physical exercise will prepare the cardiovascular and respiratory system (heart and lungs), will modify the metabolic state for good and will boost the immune system. In my opinion, effect of such holistic approach is as important in successful outcome of an operation as surgery itself. 

• day -2     oral antibiotic, liquid food
• day -1 admission to ward, oral antibiotic, oral bowel prep, iv fluid, oral clear fluid, carbohydrate loading 
• day 0 iv antibiotic, carbohydrate loading, surgery, iv fluid, protein-energy drink, mobilization 
• day 1 mobilization, liquid food+protein energy drink 
• day 2 possible discharge home. If not, same as day 1 
• day 3 usual day of discharge

The operation performed through 3 or 4 small incisions (0.5-1.5cm) and the cancer is removed from the abdomen through a 6-10cm incision, called minilaparotomy.

The cancer with a segment of bowel and adjacent lymph nodes will be taken and the free ends of bowels are joined together with stitches or surgical stapler to restore continuity.

To minimize pain, epidural anesthesia and local anesthesia applied besides general anesthesia. In line with Early Recovery After Surgery protocols, early mobilization is encouraged and patients can resume oral feeding on the day of surgery.

In case of rectal cancer, a diverting stoma - end of bowel through which bowel content can empty into a bag attached onto the abdominal wall- is sometimes needed, but most often temporary. Need for a stoma can well be predicted and will be discussed beforehand.

The removed cancer will be sent for pathological examination. The result will establish the exact diagnosis, stage of disease, will guide further management and can predict long term outcome.