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more articles by Schwed, David A. , MD  |  author's bio

Advances in Colon Cancer Surgery

Advances in Colon Cancer Surgery


By David Schwed, MD



There has been a rather significant paradigm shift in colon surgery that makes the surgical experience much more easily tolerated by patients and promotes faster recovery. This new approach, sometimes referred to as fast track colon surgery, is being performed at Cayuga Medical Center for patients undergoing surgery for colon cancer and diverticulitis.


How is the new approach different?


Fast track colon surgery is different from standard colon surgery in several ways, the biggest difference being that it is no longer necessary to clean out the bowel with a colonic before surgery. Traditional colon surgery required patients to consume large amounts of fluid laxative to irrigate or cleanse the bowel. This unpleasant process sent people running into the bathroom repeatedly the night before surgery. The thinking behind this had been that because the bowel contains a vast amount of bacteria, cleaning it out before surgery would reduce the risk of infection.


Surgical data has shown, however, that completely cleaning out the bowel prior to surgery does not have an impact on infection. In fact, the bowel’s natural function is synergistic with bacteria. Our colon bacteria and our bodies have evolved to work in sync, so even during surgery, our bodies function better with our natural bacterial content undisturbed.


How is this advantageous to patients?


The advantage of not cleansing the bowel is that patients regain natural bowel function much more quickly. In traditional colon surgery, patients don’t eat or drink much for three to five days after their operation, which is due to a disruption in bowel function. With fast track colon surgery, the bowel is disturbed as little as possible, and people are able to begin drinking fluids the afternoon of the surgery. This is a big change from the traditional surgical approach and is very much appreciated by patients. Additionally, by leaving colonic bacteria intact, patients are able to return to their natural diets much more quickly, which enhances the healing and recovery processes.


Does fast track surgery reduce pain?


Fast track colon surgery utilizes laparoscopic techniques. This means that the surgery is performed through three or four very small incisions using specially designed instruments. These allow the surgeon to operate inside the body without creating a long, open incision. As a result, post-operative pain is less severe and patients require less pain medication. Patients are able to be out of bed and ambulating more quickly, and tend to recuperate more quickly in their daily activities.


Furthermore, fast tract colon surgery typically makes use of epidural anesthesia. This serves two functions: First, epidurals enhance the return of natural function by blocking nerve pathways that slow bowel function; second, epidurals help alleviate post-operative pain so there is a greatly reduced need for narcotic pain relief.  This is significant not only for reasons of comfort, but because powerful narcotic pain medicines often cause nausea and constipation, further disrupting bowel function and recovery. Thus, epidurals often result in a more rapid return of appetite and bowel function.


Fast track colon surgery allows patients to resume their normal schedule and return to their regular activities as quickly as possible. Their hospital stay is often significantly shorter than with traditional colon surgery, which frequently requires a five-to-ten-day hospital stay. Surgeons at Cayuga Medical Center are using this innovative surgical approach to treating colon cancer and diverticulitis with excellent results.


Dr. Schwed is board certified in general surgery and is a member of the medical staff at Cayuga Medical Center. He is in practice with Surgical Associates of Ithaca, where he can be reached at (607) 273-3161. For additional information, go to or





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