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Patient information
Surgery for cancer of the bowel - anterior resection
Your doctor has recommended that you have an operation called an anterior resection to remove
the cancer in your bowel. This information explains what the operation involves and answers some
common questions that you may have.
What does this operation involve?
An anterior resection is carried out for tumours of the sigmoid colon and rectum. The operation
can be performed as an open surgery (where an incision is usually made down the centre of the
abdomen) or laparascopic / robotic (where small cuts and instruments are used to access the
abdomen) and the affected part of bowel and the surrounding tissue and lymph nodes are
removed.
Before surgery
After surgery
Part of the sigmoid colon and part of the rectum are removed and the large bowel is then re-
attached to the rectum.
In some cases, it may be necessary to form a stoma. This is usually temporary. A stoma is where
part of the bowel is brought onto the abdominal wall. The waste matter from the bowel will pass
through the stoma into a bag. This is generally decided before the operation and your doctor and
specialist nurse will discuss this with you and arrange for you to see the stoma nurse if required.
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Revised: April 2021 Planned review: April 2024
© The Royal Marsden NHS Foundation Trust GI-0933-06
The operation takes approximately 2-4 hours. The length of hospital stay varies between
individuals depending on their recovery but it is usually between five and ten days.
All the tissue is looked at under a microscope to check that the cancer has been completely
removed. The result of this test (histology) takes about 2-3 weeks.
What are the risks and complications of surgery?
Complications can happen which will slow down recovery and if they become serious, can carry a
small risk of death.
As with any major surgery, there are also risks related to having a general anaesthetic. You will
meet with an anaesthetist before your operation to discuss your general health. Your surgeon will
discuss other possible risks with you. You may find The Royal Marsden booklet Your operation and
anaesthetic helpful. It gives general information about what happens before and after an
operation.
These are the most common complications:
• Leakage at the anastomosis (join) - in a small number of patients, the join in the bowel can
leak where it has been stitched together. This can result in further surgery or your surgeon may
choose to rest your bowel, by not allowing you to eat and drink. This will allow the join to heal.
• Infection - there is an increased risk of developing an infection after the operation. This can
affect your chest, urinary tract or your wound. If you do develop an infection, we will treat it
quickly, often by giving you antibiotics.
• Blood clot (thrombosis) - the risk of developing a deep vein thrombosis (DVT), a blood clot in
the leg or a pulmonary embolism (PE), a blood clot in the lung, increases after any surgery. To
prevent this happening, you will be asked to wear special stockings while you are in hospital.
We will also give you a small daily injection of an anticoagulant, which reduces the body's ability
to form a DVT.
• Slow bowel (ileus) - occasionally the bowel is slow to start working again because of the effects
of the anaesthetic, and the bowel being handled and repositioned during the operation. This
may just take some time to get back to normal.
• Sexual function - during surgery, the surgeon may come into contact with important nerves
responsible for sexual function. If you find you are experiencing problems, please tell your
doctor or specialist nurse.
What happens before my operation?
You will attend a pre-assessment clinic to check that you are fit enough to have a general
anaesthetic and an operation. This check may include further tests such as heart and lung tests,
and you are likely to be at the hospital for a few hours. If you have a history of heart problems, you
may need to see a cardiologist (heart specialist) for assessment.
You will meet members of the team looking after you, including an anaesthetist, a clinical nurse
specialist (CNS) and sometimes a dietitian. You will see a physiotherapist either here or when you
are admitted to the ward.
The physiotherapist will talk to you about your general health and level of activity, and will assess
your breathing and mobility. You will also be offered a visit to the Critical Care Unit (CCU) and the
ward.
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Revised: April 2021 Planned review: April 2024
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Bowel preparation
You may need bowel preparation before surgery. You will be asked to take a laxative the day
before your surgery. This will cause diarrhoea and empty the bowel. Your nurse will provide you
with the information and advise you on what to eat and drink.
What happens immediately after the operation?
You will be taken to the CCU where nursing staff will watch you closely for several days and try to
make you as comfortable as possible. During your stay on CCU, only two visitors are allowed at
any one time. This is to allow both you and other patients time to recover from surgery. Visiting
times for CCU are restricted. Visitors can come to see you between 11am and 8pm. Unfortunately,
flowers are not allowed on the unit (for infection control purposes). However, they can be kept on
the ward for you to enjoy when you return there.
Good pain relief after surgery is important. It prevents discomfort and helps you recover more
quickly. Normally before the operation, an anaesthetist will discuss with you the different ways
your pain can be controlled. More information on pain relief after surgery is available in The Royal
Marsden booklet Your operation and anaesthetic.
When you wake up after the operation, you may be aware of several tubes coming out of your
body. Some of them may provide fluid or nutrition and medication. Some of these tubes may be
attached to monitors. These help the staff check your progress and provide you with fluids and
medication. Some of the monitors and pumps may alarm at regular intervals. This does not
necessarily mean something is wrong. Other tubes will drain away fluids.
You may notice the following tubes:
• Intravenous cannulae / central venous catheter - these tubes give fluids, pain relief and
antibiotics directly into a vein. One is usually inserted into a vein in the side of your neck and
another into a vein in your arm.
• Nasogastric tube - this tube is passed through your nose and down the back of your throat into
your stomach. This is inserted during the operation and drains away secretions from your
stomach. It can also help nausea and vomiting.
• Urinary catheter - immediately after the operation, it can be difficult for you to pass urine while
lying in bed. This tube is put into your bladder during the operation and drains your urine into a
bag and allows the nurses to monitor your urine output. This saves you from having to get up to
pass urine.
• Epidural catheter - an epidural catheter is a small plastic tube placed into the spinal column.
Pain relief (analgesia) is slowly and continuously pumped through it. The epidural will be
stopped when members of the specialist pain control team feel you no longer need it. Once the
epidural has been stopped, you will be given pain medicines by mouth.
• Wound drains - these are put in to drain away any blood or fluid that collects around the
operation site.
Recovering from your operation
Most patients stay in hospital for 7-10 days after surgery.
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Revised: April 2021 Planned review: April 2024
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Physiotherapy - after your operation you will be encouraged to start moving about as soon as
possible. This is an important part of your recovery and helps to reduce the risk of complications.
The physiotherapist will encourage regular leg exercises and deep breathing.
Eating and drinking - your surgeon will advise you on when you can start eating and drinking. You
will usually be allowed to start sipping water within one to two days and then build up slowly to a
light diet. Due to your bowel being handled and repositioned during the operation, it may be slow
to start working again, so you should not start eating and drinking straight away.
Bowels - your bowels will usually start to make sounds after 2-3 days and you may have a bowel
movement after 4-5 days. This varies between individuals. Usually the first sign that your bowel is
beginning to work is when you pass wind. You may then find that your bowel habits become
unpredictable and you may suffer with urgency, frequency and a change in colour and consistency.
If your surgeon has formed a temporary stoma (an ileostomy), the output will initially be very
watery. This will thicken as you start eating and drinking normally. The nurses will check your
stoma closely.
Going home
You will be given contact numbers and names of your specialist nurse and doctors so you can
continue to receive information and support. Please call them if you have any problems once you
are at home. District nurses/stoma care nurses and any other support you require will be arranged
by the ward nurses before you go home.
When will I be able to start doing normal daily activities?
Although you are well enough to go home, it will be a few months before you recover fully. Expect
to feel tired up to several weeks/months after your operation. Gradually increase your activity
every couple of days. Try to alternate periods of gentle activity, such as walking and climbing
stairs. Listen to your body and increase any activity gradually.
It is important to rest regularly. The general rule is to go gently for the first six weeks after your
operation while your wound and muscles have time to heal. Do not do anything that includes
pushing, pulling, stretching or twisting activities. You should not lift anything heavier than 1kg
(equivalent to a bag of sugar).
Do not carry out activities such as carrying shopping, lifting children, lifting wet washing, and
ironing, vacuuming or moving furniture for the first six weeks. After this time, introduce these
activities gradually and slowly build up the amount you do.
Returning to work - this will depend on your job and how quickly you recover from your
operation. Your doctor and specialist nurse will be able to advise you.
Driving - you may resume driving from about six weeks, once you are able to move freely and
quickly, concentrate sufficiently and tolerate the pressure of the seat belt on your wound. You
should be able to react and move fast enough should you need to make an emergency stop. Also
check that your insurance is valid after major surgery.
Diet - after having an operation on your bowel there are no particular changes that you should
make to what you eat and drink. You should eat a healthy balanced diet. If you have any concerns,
please talk to your doctor or specialist nurse.
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Revised: April 2021 Planned review: April 2024
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Bowels / stoma - some people continue to experience unpredictable bowel habits. These may be
improved by altering your diet and medication. You should always inform your doctor and
specialist nurse or stoma care nurse so that they can advise you appropriately.
Sexual activities - once you have recovered from your operation, there is no medical reason why
you should not resume your normal sex life when you feel ready. Occasionally, operations on the
anus and rectum can cause damage to nerves connected to the sexual organs. If this occurs, men
may find it difficult to maintain an erection and women may suffer with problems such as pain and
dryness. If you do develop problems, please inform your doctor or specialist nurse.
Psychological issues - having an operation can be very stressful and some days you may feel
tearful, sluggish and low in mood. This is perfectly normal and you should start to feel better as
your fitness returns to normal. If you are finding it difficult to cope or would just like someone to
talk to, please inform your specialist nurse.
Outpatients follow up - we expect your recovery to continue when you go home. You will be
given your first outpatients appointment for 2-3 weeks' time. Here your progress will be
monitored and the pathology results discussed with you. If you have any problems, please contact
your team.
Contact details
Often you may have questions you wish to ask. Writing these down beforehand may help you to
remember them. You are also welcome to bring someone with you to your appointments.
Your key worker will give you their contact card with their details.
Alternatively, please call:
The Royal Marsden Macmillan Hotline: 020 8915 6899
(available 24 hours a day, 7 days a week)
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