What is Anterior Resection ?
Anterior resection is surgical procedure commonly used to treat rectal cancers. Under this procedure, the entire rectum or portion of the rectum is removed, depending upon the extent of malignancy. Anterior resection is also known as lower anterior resection or anterior resection of the rectum in medical terminology. It may be chosen as the stand-alone treatment or may be combined with radio-therapy or chemotherapy.
Definition of rectum :
The rectum is the last or final straight portion of the large intestine. It forms a part of the digestive tract. It is also termed as straight gut and measures about 12 cms long. It stores waste material or feces. The internal and external sphincter allows the feces to be expelled by muscles pulling the anus up over the exiting feces.
Anterior resection Procedure :
The rectum comprises of three portions the upper, mid and lower sections. Lower anterior resection involves removal of the two-thirds of the lower rectum. In high anterior resection, the sigmoid colon is also removed. There are two types of anterior resection procedure.
Laparotomy or Open surgery :
Traditional method of surgery is followed wherein the surgeon makes an incision in the abdomen big enough to remove the diseased portion of the rectum. The incision is very long and may take about 10 days to heal.
Laparoscopy or Keyhole Surgery :
In this procedure the surgeon uses specialist instruments guided by a camera through small incisions made on the abdomen. The cancer- ridden portion is ejected carefully.
Both techniques are widely used and quite effective. However, keyhole surgery has certain benefits such as faster healing of wounds, speedy recovery, less of post- operative pain and very little scarring. The surgeon considers either of the procedures based on the prognosis of the patient while taking into consideration the age, body mass index and allied medical conditions.
Laparotomy or open surgery is longer in duration compared to keyhole procedure. The remaining part of the rectum is joined with the healthy portion of the bowel or anastomosed by stapling or stitching both the ends. Stoma formation involves the surgeon making a small hole in the tummy area and a part of the bowel is brought to the abdominal area and stitched to the skin, the bowel wastes come out of the stoma and get collected in a bag that covers it.
Before the anterior resection procedure :
A thorough assessment of the patient is done through routine investigations such as blood tests scans to determine the extent of malignancy in the rectum. The patient is mentally prepared to undergo the operation and is advised to keep his bowels empty before the surgery. The heart and lung condition of the patients are monitored to avoid any post-surgery complications.
After the anterior resection procedure :
The first 24 hour period is very crucial and the patient is kept in the intensive care unit to be monitored extensively. A catheter is normally kept in place for 48 hours to drain the bladder. Occasionally an abdominal drain is used. This is normally removed after a few days. Pain relievers are administered to ease post surgery pains. The team of cancer care professionals in KIMS, works on the fundamental principle of “Enhanced Recovery After surgery”. Your day to day improvement is analyzed to help you recover faster by providing expert psychological counseling and post surgical care that has helped many patients in Hyderabad.
Benefits of the procedure :
The first benefit would be that the arrest of cancer is done. It also ensures that the malignancy does not extend further and forms a basis for allied cancer therapies such as chemotherapy or radiations to kill the cancerous condition.
Complications of the procedure: The procedure has certain potential risks involved, which can be avoided through focused treatment. The main risks are:
- Ileus - temporary shutdown in bowel movement. The bowel is slow to start working, therefore, the bowel needs to be relaxed (restricted fluid intake orally and no food intake), one will be given intravenous fluids via a drip to replace fluids lost and one may need a nasal-gastric tube (tube placed through the nose into the stomach) inserted to prevent vomiting. This would remain until the bowel recovers and starts working.
- Anastomotic leak - Occasionally bowel control is bad and patients may experience leakage.
- Loss of Capacity- In certain cases, patients complain of increased bowel frequency looseness or difficulty evacuating their bowels.
- Stoma retraction/perfusion - retraction describes a stoma that has sunk below the skin level. Perfusion refers to the change in blood supply affecting the stoma.
- Other potential damages though very rare may include nerve damage, bladder damage, sexual dysfunction, urinary tract infections, chest infections, pulmonary embolism, deep vein thrombosis, parastomal hernia, and scarring.
The mortality rate after anterior resection is less than 5%. The patient regains his mobility within a month.
At KIMS, Our dedicated oncologists have mastered the procedure and treated many patients successfully. We offer a comprehensive treatment by involving the patient and his family members. Our oncologists ensure that post-surgery complications don’t arise, and focus on achieving the best possible positive outcome even in critical and high-risk cases.