Surgeon Explains Rectal Cancer Surgery

Surgical oncologist explains rectal cancer surgery, use of chemotherapy and radiation, and differences from colon cancer. The surgery for rectal cancer is the most complicated of the colon and rectal cancer surgeries. This is because you have to remove the rectum from the fat and organs in the pelvis. The other organs such as uterus and vagina in women or bladder and prostate in men are very close to the rectum. The ureter tubes drain urine from the kidney to the bladder and are also close to the end of the colon and the rectum. For rectal cancer surgery, we want to remove at least 12 lymph nodes. Rectal cancer drains to lymph nodes all the way up by the sigmoid colon. The lymph nodes are intertwined with the blood vessels supplying the rectum and lower sigmoid colon. In order to remove the 12 lymph nodes we usually have to remove about one foot or more of the end of the sigmoid and rectum to at least 2 cm below the rectal cancer. In order for the remaining colon to reach into the pelvis to reconnect to the remaining rectum we have to release attachments at the splenic flexure and the left descending colon. The colon is reattached to the stump of rectum left with either a stapling device or by sewing by hand. This surgery is called a low anterior resection or abbreviated as LAR. Lastly, if the patient has had radiation before surgery this can make healing worse so we usually do not trust the re-connection of the colon and rectum not to leak as it is healing. Commonly after radiation for rectal cancer, when we remove the rectum and reconnect the colon to the remaining stump of rectum we recommend diverting stool away from the colon while it is healing - this is done with a small bowel ostomy called a loop ileostomy. This package surgery is a LAR with diverting ileostomy. The stool come out from the end of the small intestine into a bag. After several weeks or months a surgery can be done to reconnect the small intestine and stool will go back through the colon and out from the now-healed reconnected colon and rectum. For large rectal cancer or rectal cancer that is very close to the anus - sometimes a surgeon cannot reconnect the colon to any rectum that is left. If this is the case, then we may have to remove the entire rectum along with the anus and sew the space where the anus was shut completely. This obviously requires a colostomy which is brought up to the skin from the end of the remaining colon and this is a permanent colostomy for the rest of your life. This surgery is called an abdominoperineal resection abbreviated as APR. Adenocarcinoma of the colon is usually removed with surgery then chemotherapy is given if needed. Radiation is rarely used in colon cancer. One major difference between colon and rectal cancer is that rectal cancer frequently uses radiation. The wall of the rectum has layers and the middle layer is muscle. For early rectal cancer that has not invaded through the muscle layer in the wall located in the rectum you may just have surgery and not get chemotherapy or radiation. But if the cancer is growing deep into the wall of the rectum through this muscle layer or looks like it is already in lymph nodes on x-rays - then we will commonly use radiation before doing surgery. Radiation helps shrink the tumor making surgery easier and can decrease regrowth of the tumor. If you are getting radiation for rectal cancer you will frequently be given a very light version of chemotherapy that makes the radiation work better. True chemotherapy with multiple types of chemo is not given at the same time as radiation as this can cause too many side effects. Radiation with “lite chemo” lasts 5-6 weeks. Radiation is given with a big machine and the invisible beams will travel through the area of the rectal cancer. This is given by a radiation oncologist doctor. After finishing radiation we wait 6-10 weeks to allow the tissue to recover before doing surgery. After radiation we typically do surgery next then chemotherapy - if needed - comes last. So quick recap - early rectal cancer not growing through the muscle of the wall of the rectum gets surgery and no other treatment. Deeper rectal cancer growing through muscle layer or into lymph nodes gets radiation with “lite chemo”, then surgery, then chemotherapy after.
Sometimes if a cancer is very small and early and has not grown into the muscle of the wall of the rectum and is in the lower third of the rectum, we may be able to remove it from the anal opening just by taking out a part of the wall of the rectum and stitching it shut. This is called a trans-anal excision. This is only for very small early rectal cancer and is sparingly used since we cannot check lymph nodes with this technique.

[@namir1782]

10mins and clearer than what my teacher explained in a whole lecture thanks !

[@caysonfletcher1089]

You prolly dont care at all but does anybody know a tool to get back into an Instagram account? I stupidly forgot the login password. I would love any tips you can offer me.

[@barbaradollard4186]

You are an amazing person and after seeing your video I believe you have helped so many people like myself to understand it all. Glad I found you, my mom was diagnosed in January, being 94 we chose not to put her through any radiation or chemotherapy , so far her only symptom is diarrhea, other than that she’s healthy and doing well, it’s just scary watching and waiting, praying she will not have pain in her future, just want her to be comfortable in this part of her life.

[@msodicka]

Thankyou so much for explaining so good. Hope my father to live long after surgery ose chemo. We still dont now yet what CT scan will show. Hope the tumour is located only inside the wall. The doctors said that tumour is 6 cm located i the middle part of rectum. Please pray for my dad. I still need him in my life. 🙏😥❤

[@helendolan7716]

Hope he os doing ok my sister has just started on tests to see if it is this as she thought she had piles and it was so painful to sit down

[@kennyhussein3435]

How's he doing now? I hope he's fine now

[@mr8815]

He will be fine InshALLAH

[@kennyhussein3435]

How's he doing now?

[@arijitbarmanamarkobita120]

How's ur dad now dear?

[@michaeljohnchristophet3949]

A GREAT explanation...clear, concise, and to the point !

[@brendapippens8936]

Thank you for this information I had colon cancer surgery NY doctor said it was a hard surgery to do but by the grace of god he did it on did a Awesome job your information gave me a clear picture how them surgery is done thank you so very much i'm feeling so much better it's been two weeks after my surgery is feel great thanks again be blessed god bless you

[@kennyhussein3435]

How are you feeling now? I hope you are much better than before... Did you experience any symptoms since then?

[@nigaraltowheed379]

You have ilostomy or not?

[@dragonbone5000]

First clear and helpful video I’ve seen. Thank you.

[@mojesimore8054]

Thanx for this explanation. My mom had LAR last Monday and everything went well. Thanx for easy explanation with sketches and without horror movies of cancer surgery...

[@venturasurgeryschool796]

I am glad it helped

[@HaiderAli-yk9ve]

@@venturasurgeryschool796 hi. Plz make more such vedios on surgery topics

[@meerahm3345]

How’s your mon doing? Do you mind if I asked what stage did she had? Thanks

[@MrJpdas]

@@venturasurgeryschool796 sir iam oparated rectum cancer 2020 after oparation robotic surgery apolo chennai india but after oparation anything eating brakefast lanch dinner imidiate going to washroom 4 to 5 time toilet passing stool sir 🙏 plz what diet best to me reduce to problem

[@narenderpawdia9508]

@@MrJpdas how is ur problem now bro. Improved or not

[@gracebolt-formteacher342]

Thanks for this comprehensive video. My mother is about to do this surgery and you have brought light to process

[@ahmedali-bk2rx]

Now how are your mother ?🙏🏻❤

[@tessmiddleton8998]

Thank you doctor for that very detailed explaination on how is rectal cancer operationis done.

[@Teaganderry]

If a cancer has not reached the muscle layer (muscularis), we can also perform an ESD - Endoscopic Submucosal Resection. We have done this procedure on a number of people with great results, saving them from having to experience any surgery!

[@martinkennedy2400]

...for your time & knowledge & clarity: thanks

[@retrogal8888]

I'm about to have this done. Fantastic video, thankyou xx

[@ShaleyJean]

Thank you for this very informative video! I go to the gastroenterologist tomorrow as I have most of the symptoms.

[@gwenstein5517]

Wow, excellent explanations. I'm reviewing for my ostomy exam. Thanks so much. ❤

[@TSquared2001]

This is truly timely

[@CBReal1290]

Excellent drawings with spoken detail… helps visualize and understand possible outcomes

[@user-jc7xp8lk6v]

Thank you for your explanation. My wife had small cell carcinoma in her rectum. After chemo ,radiation and reconstructive surgery she survived, although she has a colosomy bag that she has for life.

[@Andrea-pv9fg]

Great explanation, thank you

[@anniemathew7038]

Great presentation 🙏❤️

[@nancyrollno6370]

Amazingly explained sir🙌

[@lisaunderwood809]

So very helpful!! Thank you!

[@michaeljohnchristophet3949]

Wow ! Excellent Video & Audio !

[@JoshuaFinancialPL]

much appreciated. happening to me right now.

[@mcdougal0]

Very helpful, thanks a lot.

[@abdullahbasa9937]

Great video,thank you so much

[@ak99251]

Great lecture! Thank you

[@jessijacobs8]

Very good and understandable explanation 👍 👏

[@rafaelbatista5452]

Very good 👍 👏 I feel ready to accept the outcome now.

[@yashalnaeem]

Thankyou for this video

[@tejaswinimudri8927]

This was the most helpful video on this topic. Thank you so much

[@IndianHouseOfDosasPiscataway]

You are simply superb in explaining. Its my bad luck, i got this VDO now. Post to my colon rectum cancer, which was 2 years back, i am experiencing the ED. Unable to regain. I am 50 years with no other health issues or on medication. I carry stoma bag. I was told its impossible to avoid stoma bag. I was a yoga practitioner due to stoma bag i am unable to do good exercises and my belly increased, now i follow diet with proper nutrition i still did not find any effect. My request how overcome with ED? Please doctor your suggestions must definitely help me.

[@carrieraa]

I was told that having stoma will not stop me from exercising. Why are you unable to do yoga?

[@nikoletemplin3498]

Is there a time that chemo and radiation can shrink it and no surgery is needed?

[@kimtae6570]

Helped me alot thanks❤

[@daveaver2804]

Just watched after 9 months post reconnection and complete LAR treatment. The LAR syndrome continues but a great video.

[@honeybhingful]

Hello! My mom is Stage 3 and just about to undergo radiotherapy. When is an ileostomy necessary? (since this is what we're avoiding) Your comment is the first time I encountered 'LAR Syndrome', so I'm curious if you have had any workarounds with it?

[@nigaraltowheed379]

@@honeybhingful you're mother have ilostomy?

[@holdmy]

Thank you ❤

[@loanna3648]

best explanation of this topic, wide enough to connect different knowledge point for med students... hope the content can get a bit deeper next time eg exact indication with different scenarios

[@theKaufmanTapes]

Very educational!

[@basungprideprido1370]

Am really impressed

[@lenaajeesh7731]

Thanku

[@Specialdunk1814]

Best video I’ve seen.

[@Medtutorsperexcellence1]

Very interesting video ❤

[@sitakc6008]

I want to know if radiotherapy and kimo therapy work well ,it is compulsion to have surgery or. Not

[@kenobi3624]

Great👍

[@LP-fw3wl]

Please be aware of Lar syndrome from LAR surgery. This syndrome is very hard to live with..low quality of life, this is worst if chemo/ radiation involved

[@helpu2health]

Thank you for this video. I was diagnosed with rectal cancer on december 12, 2023.... I am scheduled to start radiation therapy at the beginning of February for 5 weeks at 5 times per week.... A month after my radiation therapy ends i will start 6 3 week cycles of chemo... Since the mass is on the anal verge of my Rectum The goal is to shrink the mass enough to where they can repair it Without me having To have a permanent colostomy bag....

[@jenifermurali2625]

Can I have ur number plz

[@jenifermurali2625]

Where is ur native

[@zorahp2548]

My husband also got the same problem He will start chemo next

[@zorahp2548]

Iwish you well

[@idapedram9391]

Thank you so much for your description...unfortunately my dad, who was a physician ,died from malignant malanoma of rectum recently; which has no sign but some red blood in stool and because my dad had hemoroid,when he understood it was very late,even they couldn't do the surgery😔.I'm 39 now and asked my docror for a check up but he said melanoma has nothing to do with genetics! I wonder if it's correct.

[@sheilagoos645]

I would pay for it myself (if necessary) and probably get a different doctor. As you know, rectal or anal cancer is dangerous.

[@nellsmith169]

Ida please have a colonoscopy ASAP - I was diagnosed 9 months ago with stage 3 rectal cancer and no typical symptoms - like blood in my stool. My son who is 38 recently had his first colonoscopy at the recommendation of my oncologist and he had polyps removed! Colorectal cancer is affecting many more younger people. Be your own advocate and demand that your doctor order a colonoscopy for you. I wish you all the best.

[@kimemjaycastro9723]

Hello doc, i just watch your explanation, and differences. I will ask what to do because my mom suffered pain in the rectum, she already have 2 surgery. But still have pain in the stomach and the rectum. She is now malnourished and need to make chemo but her body is very weak. We can’t choose what to do, she will go chemo but her body is very weak, or we wait her to be strong enough before she go chemo? Please help us. It’s already 2 months after her 2nd surgery. Thank you

[@bobbycarroll2267]

Can you sit after APR

[@21550spurs]

You did not mention taTME surgery

[@terencegalati970]

Well done. CRC screening needs more attention. Early detection is key to survival. As invasive as the surgery is, the treatment is much worse. The bags are inconvenient, but CRC surgery is lifesaving. You only need to live long enough for the next miracle cure. Find a clinical trial.

[@monica93304]

Thank you for the video. This was a lot of info. I've had periods off and on of bloody stool, hemroid flare ups. Painful stools when I was given phentermine for weight control. I was so constipated. When switching to my new insurance, I was given the at home test to screen for problems. I'm going in for a colonoscopy in less than two weeks. I'm nervous to be honest.

[@joannalouise]

I hope it all goes well and that all is ok :) I had my first colonoscopy just over a week ago and I will be back in for surgery tomorrow ❤

[@monica93304]

@@joannalouise hello...I go in tomorrow morning for my colonoscopy. I'm doing the prep as we speak. Thank you for your kind thoughts ❤️ . I hope that your surgery is a success. My mind has been racing because of the unknown.

[@joannalouise]

@@monica93304 ah Monica! You and I are twinning as I am also doing the prep currently. Just remember that no matter what, it is the not knowing that causes the most stress. Stay positive. I will you in my thoughts today and hope everything works out fine :) you may just have a small polyp, if anything, which in 95% of cases are harmless and can be removed during your colonoscopy.

[@lewiscannon8213]

Monica how are you doing 1 year on?

[@monica93304]

@lewiscannon8213 in the 1st colonoscopy, they removed several polyps. One was golf ball size. But two were NET's (Neuroendocrine tumors/malignant). So in the follow up colonoscopy, they went back in and checked the areas marked with the cancer, and everything came out negative. So I'm relieved. I'm due for bariatric surgery in two weeks. Soon after that, I'll schedule my yearly colonoscopy. Thank you for asking.

[@raphaeladedayo7401]

@Ventura Surgery School I've had the surgery about 6 months now. For about 2months now I feel discomfort in my rectum with poor urine flow and no erection. The discomfort is just too much such that I get temporal relief after visiting the toilet. Urological tests carried out after the LAR points to "nerve damage" but the surgeons are not admitting to this. Going in for ileostomy reversal in 2 weeks time and I pray everything else gets corrected. What do you suggest I can do to get relieved of the rectum discomfort and no erection?

[@nigaraltowheed379]

Your reversal is successful?

[@user-kw3gz6xz8t]

God thanks!

[@michellelanigan2561]

Hey Bill… good advice. I asked about getting sewn shut too. He said not good because the collective fluids have no way out. May cause infection again. Yes, they do now. Just FYI, lol! Good to see you again!!!

[@barbarajackson8053]

Where are the sphincter muscles?

[@retrogal8888]

This is brilliant. I have to have APR Surgery with radiation first. My surgeon said my tumor is "angry" so Im having MRI PET scans And CT scans this week...

[@idapedram9391]

Hope u r doing better now

[@retrogal8888]

Didn't have surgery. Just chemo. Rectal cancer completely gone now! 50% BETTER. Just have the NETs on my lungs to go. Chemo killing me tho.....very hard.

[@idapedram9391]

@@retrogal8888 oh happy to hear that! God bless you.

[@kennyhussein3435]

How are you feeling now ? I hope you are feeling good ?

[@retrogal8888]

​@@kennyhussein3435 ...well no. Was admitted to hospital on Wednesday for pain management and chemo. So Im on morphine 4 hrly or as required.

[@manasahampikar8202]

Hi ,my dad is suffering from same cancer ill send u the reports can u suggest me which surgery is better

[@gurvinderkaur4553]

Why they don’t reply to our questions?

[@manasahampikar8202]

I dont know

[@pratikgupta2201]

How is he now. What was the treatment

[@maroontarabyn6697]

How much would cost to cure it?

[@sinonistoyemi6327]

metabolic therapy is the one to go for in combination with nanoknife

[@alsharifhusain]

I had a rectum cancer 💔 Oxipilatin and xeloda Thank you for explanation ❤️❤️❤️❤️

[@natashaaggarwal6127]

From where you get treatment? My sister has rectal cancer and I want someone help to treat her. Kindly do help

[@alsharifhusain]

@@natashaaggarwal6127 sorry I am busy about my medication these days. I don’t know which stage is she. She needs some steps : Biopsy Ileostomy bag ( or colostomy) Port à cath Chemotherapy (oxaliplatin and xeloda) Radiotherapy Mesorectal surgeryo Maybe chemotherapy again Wish you and your sister in good health

[@alsharifhusain]

@@natashaaggarwal6127 Saudi Arabia 🇸🇦

[@kennyhussein3435]

What if you have been having all these symptoms and you think it’s an hemorrhoid, after 3years you found out it’s a cancer , can it still be treated?

[@alsharifhusain]

@@kennyhussein3435 inshallah you can👍👍👍don’t give up

[@Anandpare1975]

Sir, the tumer is above 2 CM from anes, can i save from permanent stoma beg?

[@sangitajaiswar9045]

Jesus can save you my brother 🙏

[@kennyhussein3435]

How are you feeling now?

[@Anandpare1975]

@@kennyhussein3435 I have also had reversal surgery, but now I am facing a lot of problems.

[@kennyhussein3435]

@@Anandpare1975 oh my God. I'm sorry about that., You mean you won't advise anyone to undergo such surgery. I'm having similar pain in my anus , I was told it's not an hemorrhoids and it's likely to be a cancer and will be undergoing a surgery soon but I'm really scared. What do you advise please! 🥺

[@kennyhussein3435]

Please, can I also know the problems you are facing?

[@kennyhussein3435]

What if you have been having all these symptoms and you think it’s an hemorrhoid, after 3years you found out it’s a cancer , can it still be treated?

[@KDRRR711]

What symptoms did you have?

[@kennyhussein3435]

@@KDRRR711 I bleed while stooling, it's very difficult to stool either it's hard or soft . It's difficult to pass out stool and when it comes out, I go through a lot of serious severe pains for about 15hours for real ... This is has been occuring for the past 3years and few weeks ago I noticed a lump swelling at the side of the anus. It's so painful when I stool... Now I'm about going for a surgery and this would determine if this is a cancer or hemorrhoids and anal fissure... Do you think this is an anal cancer ??

[@safarahman4546]

​@@kennyhussein3435 can u share ur condition now?? Actulally i have same symptoms as urs.. Iam facing this since 5 months😢

[@kennyhussein3435]

@@safarahman4546 slm, I undergo a surgery 3weeks ago that changed my life.. honestly I'm really getting much better now. I don't feel any symptoms... I would advise you consult a specialist ( a surgeon professional) on this issues. InShaaAllah you will be fine. They will let you know if it's surgery you would go for or other medications... If medications doesn't work, believe me honestly surgery is the best. You can write me on FB or Whatsapp if you need more questions to be answered concerning this.

[@safarahman4546]

@@kennyhussein3435 bro may i know have u done any test before surgery?

[@ahmedali-bk2rx]

Total mesorectal excision 😢 where 😢

[@krisstrong5936]

ok so what's colon cancer then? they sound the same other than location.

[@sheilagoos645]

Treatment is different. Rectum is surrounded by layers which contain lymph nodes and blood vessels.

[@okpunjabtv5577]

my mother is dead this case after the 9 month operation😥😥

[@hayaa800]

Ohhh .. operation or TACE?

[@jibrilthegreat35]

I was just staged T1-2 N1 M0 The tumor is 1.6 cm away from the anal sphyncers. My CEA was 2.0 I see my oncologist tomorrow. Im scared 😢

[@okpunjabtv5577]

😥 my mother death after long chemotherapy

[@royferguson2297]

I had it twice second time had anus etc removed.

[@ibanrikordorlyngdoh3500]

Expert lecture but practically no idea to cure

[@MarcoFernandes-dq3dv]

What crap…

[@jamube94]

Hello everyone. I'm a 27 Y/O veteran/fire fighter and I eat very healthy, lift weights and run on the regular. 2 weeks ago I woke up in the morning and I could not poop. Then the stool finally started coming out but they look like ribbons. Like a gift wrapper ribbon. Constipation and ribbon-like stools. Opened Google on my phone and Ended up going to the ER where they did blood tests, rectal digital examination, and CT-scan with dye. THEY FOUND NOTHING, and the doctor even pointed out I did not even have stools backed up, with the radiologist saying not a spec inside my body and bowels looked out of the ordinary. Its been 8 days since that, and now I'm also seeing white mucus (no blood) on my stools, with 2-3 small ribbon BM a day, with two small soft lumps on the outside of my anal cavity that inflate when I push (Hemorrhoids, I'm guessing?) PLEASE HELP. I am worried sick and cannot sleep at night with the urge to poop and anxiety. please someone. I normally do not worry about stuff like this but I've been down the Reddit rabbit hole many a night and I just cannot seem to know what is happening. Gastroenterologist appointment is in a whole 15 days from now, and I am worried my condition will deteriorate.

[@idapedram9391]

Hope u r doing better now...any news?

[@sheilagoos645]

That is called stenosis. Something is blocking your stool. That was the only sign I had for my cancer. Schedule a colonoscopy ASAP. Pay for it yourself if insurance won't cover it. The anxiety will drive you crazy.

[@LThill-ks2uz]

I can't believe, or trust doctors who just say we found nothing and then do nothing more. I hope you find your answers.

[@rongiovagnoli7560]

Sign me up for that surgery right away!! Doctor I bet a million dollars you would not undergo that surgery or not recommend that surgery to any of your loved ones!!!