Colorectal Cancer Surgery in Melbourne

Colon cancer and rectal cancer are both types of colorectal cancer, but require different surgical approaches. Colon cancer surgery (colectomy) typically involves removing the affected segment of the colon and rejoining the healthy ends.

Rectal cancer surgery is more complex due to the rectum’s location deep in the pelvis and its proximity to the bladder, prostate or uterus, and the anal sphincter. Rectal cancer surgery uses a technique called total mesorectal excision (TME) to remove the rectum with its surrounding lymph node-bearing tissue intact, and often involves pre-operative radiotherapy to reduce tumour size and improve the chances of preserving the sphincter.

Not all patients require a stoma following colorectal cancer surgery. For most colon cancer operations and many rectal cancer operations, the bowel ends are rejoined, and normal bowel continuity is restored. A temporary ileostomy is commonly used to protect a low rectal anastomosis while it heals, and is reversed at a planned operation 8-12 weeks later.

A permanent colostomy is required when the entire rectum and anus are removed (abdominoperineal resection), which is reserved for cancers involving the lower rectum where sphincter preservation is not surgically or oncologically feasible. We will discuss the likelihood of any stoma with you in detail before your operation.

Most patients stay 4-7 days in the hospital following laparoscopic colorectal resection. Open surgery or more complex cases may require 7-10 days. The length of stay depends on your recovery progress, whether any complications arise, and how quickly your bowel function returns and your oral intake is established. Enhanced recovery protocols, including early mobilisation, prompt introduction of oral fluids, and multimodal pain management, are routinely used to support a smooth recovery.

Survival outcomes depend primarily on the stage of the cancer at the time of surgery. For Stage I colorectal cancer, 5-year survival rates exceed 90%.

For Stage II (cancer through the bowel wall but no lymph node involvement), survival rates are approximately 70-85%. For Stage III (lymph node involvement), survival rates range from 40-80%, depending on the number of nodes involved, and are substantially improved with adjuvant chemotherapy.

For carefully selected Stage IV patients with limited liver or lung metastases that can be resected, long-term cure is achievable ^[2]. We will discuss the specific findings from your pathology report and what they mean for your individual prognosis.

Many patients with colorectal cancer will receive additional treatment alongside surgery. For rectal cancer, pre-operative (neoadjuvant) chemoradiotherapy or radiotherapy is recommended for locally advanced tumours to shrink the cancer before surgery and reduce the risk of local recurrence.

For colon and rectal cancer, post-operative (adjuvant) chemotherapy is recommended for most patients with Stage III disease and for selected Stage II patients with high-risk features such as poor tumour differentiation, perineural or lymphovascular invasion, or inadequate lymph node sampling. This will be discussed and coordinated through our multidisciplinary team.

Colorectal cancer surgery is covered under Medicare as a surgically necessary procedure. Most patients with appropriate private hospital cover will have the majority of hospital accommodation and theatre costs covered by their health fund, subject to any applicable excess and waiting periods.

Out-of-pocket expenses typically include fees for the surgeon, anaesthetist, and surgical assistant. The amount varies depending on the complexity of the operation and your level of health fund cover. Patients without private insurance can be treated through the public hospital system via referral. We recommend contacting your health fund to confirm your entitlements before surgery. We will provide a fee estimate at your consultation.

Bowel function changes after colorectal surgery depend on the type of operation performed. Most patients who have had a segment of colon removed will have fully normal bowel function within a few weeks, though the bowel may be more active initially as it adjusts.

Patients who have had a low rectal resection may experience low anterior resection syndrome (LARS), which includes increased frequency, urgency, difficulty emptying fully, and occasional accidents. These symptoms often improve over 12-18 months, and most patients adapt well to dietary adjustments and pelvic floor physiotherapy. We will discuss what to expect based on your specific operation ^[7].

The timing of surgery depends on the type and stage of your cancer. Colon cancer surgery is typically scheduled within a few weeks of diagnosis, once staging investigations are complete. For locally advanced rectal cancer, pre-operative chemoradiotherapy is usually completed first, with surgery following 6-12 weeks later. Urgent surgery may be required if you present with bowel obstruction or perforation. We will discuss the recommended timeline for your individual situation at your consultation.

Laparoscopic colectomy is a minimally invasive approach in which the operation is performed through 4-5 small incisions using a camera and specialised instruments, rather than a single large abdominal incision. The oncological result, including the extent of bowel and lymph node removal, is equivalent to open surgery.

The advantages of the laparoscopic approach include less postoperative pain, a shorter hospital stay, lower wound complication rates, and a faster return to normal activity. Not all patients are suitable for a laparoscopic approach; factors such as prior abdominal surgery, tumour size, and technical considerations may determine that an open or converted approach is most appropriate. We will discuss the most suitable technique for your circumstances ^[3].

Recurrence is possible following colorectal cancer surgery and is most likely within the first 3 years. Local recurrence (at or near the original site) and distant recurrence (most commonly in the liver or lungs) are both monitored through regular follow-up, including CT imaging and CEA blood tests.

Regular colonoscopy surveillance is also performed to detect any new polyps or mucosal recurrence early. Adjuvant chemotherapy, when recommended, reduces the risk of recurrence in patients with Stage III disease and selected cases of Stage II disease. Attending all scheduled follow-up appointments is an important part of your ongoing care.