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
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
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
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
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 www.ithacasurgeons.com or