Right Hemicolectomy
Right colon cancer surgery

Right colon includes caecum, ascending colon and beginning of transverse colon. Cancer affecting these parts of colon are treated with right hemicolectomy.

The treatment of right colon cancer depends on the stage of the disease. Surgery is the main treatment for earlier stage colon cancer. When a surgeon operates for cancer, he removes the cancer-bearing organ or part of it to the healthy tissue along with the adjacent draining lymph nodes. Lymph nodes are small glands that are part of our lymphatic system. They are situated alongside the blood vessels that supply blood to the concerned organ. Lymph nodes play a vital role in our body's defence system. They filter and trap the cancer cells, preventing them from reaching other organs of our body (metastasis).

Lymph nodes are situated along the blood vessels.

Right hemicolectomy means surgical removal of right side of colon.

During a colectomy, the surgeon removes the diseased part of the colon with a margin of a healthy colon and draining lymph nodes. Since the lymph nodes are along the blood vessel, the blood vessel is divided at its origin to remove all the draining lymph nodes. The extent of colonic resection depends on the blood supply which is cut.

Intestinal continuity is then re-established by joining the cut ends of the intestine (anastomosis).

Ostomy

Occasionally, when the tissues are not healthy and the anastomosis is unlikely to heal. In such cases, an opening of the intestine is made over the abdomen called ostomy (ileostomy or colostomy). This is temporary and is closed after the improvement in patients' condition and chemotherapy (if required).

There are two ways to do a colectomy:

• Open, and
• Laparoscopic or Robotic

All surgeries can be associated with complications and so is the case with colon cancer surgery. Some of the common possible complications after colon cancer surgery include:

• Anastomotic leak: the joint of the intestine can leak.
• Infections - surgical site, pulmonary: Infections can occur after the surgery.
• Cardiac complication: Heart-related complications
• Bleeding: There can be bleeding during or after surgery
• Injury to adjacent organs: Many internal organs are very close to the colon. They can be injured during surgery.
• Anaesthesia related complications: There can be complications related to the administration of anaesthesia and recovery.
• Postoperative obstruction: Post-surgery intestines can stop working, a condition known as postoperative ileus. They can get stuck or entangled requiring surgery.
• Deep venous thrombosis: Clots can form in the veins of the leg due to immobility. These clots can travel to the lung also.
• Hernia: Hernia can form at the incision site.

Before surgery

Following steps will be taken to ensure the best outcome.

• Tests related to diagnosis, staging and surgical planning
• Tests related to fitness for surgery
• Optimising coexisting illness: Those with pre-existing illnesses such as diabetes, hypertension, cardiac disease etc. will be optimised to the best possible health.
• Admission and bowel preparation: Some patients will be given medicine to empty the colon before the surgery.
• Can read more about preparing for surgery here.

After surgery

You will be closely monitored while you recover. It generally goes through the following steps.

• Intensive monitoring: Monitoring takes place in the ICU or recovery room
• Removal of tubes (Nasogastric, Foley and drain): Few tubes are placed during the surgery to facilitate the recovery. They are removed sequentially.
• Start and increase the diet: The oral intake is started with clear fluids and increased to a liquid diet and soft diet over a few days.
• Discharge: Once you are fully mobile and oral intake is adequate you will be discharged with instructions to follow at home. This usually happens 4-6 days after surgery.
• Follow up: Follow up visit is planned a week or 10 days after discharge. Clips or stitches over the incision are removed. The final biopsy report and further treatment plans are discussed.