Colorectal Surgery

Surgical care for diseases of the colon and rectum

Colorectal surgery covers the assessment and surgical treatment of diseases of the colon and rectum, including colorectal cancer, diverticular disease, polyps that cannot be removed endoscopically, bowel obstruction and selected inflammatory conditions. Charalambos Charalambous is a Consultant General Surgeon at the German Medical Institute in Limassol. His clinical work focuses on surgical oncology and gastrointestinal surgery, including colorectal surgery.

Treatment is planned according to the diagnosis, the stage and extent of the disease, general health and the patient’s preferences. Cancer cases are discussed within a multidisciplinary team, bringing together imaging, pathology and the relevant oncology specialties to agree an individualized treatment plan.

Colorectal conditions

The main conditions of the colon and rectum are summarized below, and each heading links to a detailed page. Hereditary bowel cancer syndromes, such as Lynch syndrome and FAP, are covered on a separate page.

Colon cancer

What it is: A malignant tumour arising from the lining of the colon, usually developing slowly from a pre-existing polyp.

Symptoms: Change in bowel habit, blood in the stool, abdominal pain, anaemia or weight loss; it may also be detected through screening before symptoms appear.

Treatment: Surgical removal of the affected segment of colon with its lymph nodes, usually laparoscopically, followed by chemotherapy when indicated. Advanced disease is treated with systemic therapy and, in selected cases, surgery for metastases.

Rectal cancer

What it is: Cancer of the last part of the large bowel, just above the anus. Its location in the pelvis makes staging and planning particularly important.

Symptoms: Rectal bleeding, change in bowel habit, a feeling of incomplete emptying, or pelvic pain.

Treatment: Treatment is planned after pelvic MRI and may include radiotherapy or chemoradiotherapy, total mesorectal excision surgery and chemotherapy. Selected early or fully responding tumours may be managed with local excision or a watch-and-wait approach.

Colorectal polyps

What it is: Small growths on the inner lining of the large bowel. Most are benign, but some types, especially adenomas, can turn into cancer over time.

Symptoms: Usually none; occasionally bleeding or mucus.

Treatment: Removal during colonoscopy in most cases, with surveillance intervals based on the findings. Large or complex polyps may need advanced endoscopic techniques or surgery.

Diverticular disease and diverticulitis

What it is: Diverticula are small pouches that bulge outwards through weak spots in the bowel wall, most often in the sigmoid colon. Diverticulitis is inflammation or infection of these pouches.

Symptoms: Left lower abdominal pain, fever and change in bowel habit; complications include abscess, perforation, fistula, stricture or bleeding.

Treatment: Uncomplicated attacks are managed with diet and, when needed, antibiotics. Abscesses may be drained. Surgery is considered for complications, recurrent attacks affecting quality of life, or emergencies.

Crohn’s disease

What it is: A chronic inflammatory bowel disease that can affect any part of the digestive tract, most often the end of the small bowel and the colon.

Symptoms: Abdominal pain, diarrhoea, weight loss, fatigue, and sometimes strictures, fistulas or abscesses.

Treatment: Medical therapy managed with a gastroenterologist is the mainstay. Surgery, ideally bowel-preserving and minimally invasive, is used for strictures, fistulas, abscesses or disease not controlled by medication.

Ulcerative colitis

What it is: A chronic inflammatory bowel disease of the lining of the colon and rectum that starts in the rectum and may extend continuously along the colon.

Symptoms: Bloody diarrhoea, urgency, abdominal cramps and fatigue.

Treatment: Medication is the first-line treatment. Surgery, usually removal of the colon and rectum with or without an ileoanal pouch, is considered for severe flares, disease resistant to treatment or dysplasia.

Large bowel obstruction and volvulus

What it is: A blockage of the large bowel, most often caused by a tumour or a stricture, or by volvulus, the twisting of a loop of bowel on itself.

Symptoms: Abdominal distension, colicky pain, vomiting and inability to pass stool or gas.

Treatment: An emergency requiring urgent assessment. Depending on the cause, treatment may include endoscopic decompression or stenting, or surgery.

Appendicitis

What it is: Inflammation of the appendix, a small finger-shaped tube attached to the first part of the colon.

Symptoms: Pain that often starts around the navel and moves to the right lower abdomen, with loss of appetite, nausea and fever.

Treatment: Laparoscopic appendicectomy in most cases. Selected uncomplicated cases may be treated with antibiotics.

Colorectal cancer surgery

Surgery for colorectal cancer begins with accurate staging: colonoscopy with biopsies, CT of the chest, abdomen and pelvis and, for rectal cancer, pelvic MRI. The treatment plan is agreed at a multidisciplinary meeting.

For colon cancer, the affected segment of bowel is removed together with its blood supply and lymph nodes, for example by right or left hemicolectomy or sigmoid colectomy. For rectal cancer, surgery follows the principles of total mesorectal excision, and chemotherapy or radiotherapy may be recommended before or after the operation. Depending on the position of the tumour and the circumstances, a temporary or permanent stoma may be needed. More detail is available on the Colon cancer and Rectal cancer pages.

Surgical approaches

Colorectal operations may be performed as open, laparoscopic (keyhole) or robotic-assisted surgery. For many patients, minimally invasive surgery means smaller incisions and a quicker recovery, but it is not automatically the better option: the choice depends on the disease, its stage and location, previous abdominal surgery, anatomy and general health. The proposed approach, with its benefits and risks, is discussed individually before any operation.

Assessment and multidisciplinary care

Assessment includes a detailed history and examination, blood tests, colonoscopy with biopsies and, depending on the condition, CT, MRI or other imaging. Cancer treatment is planned within a multidisciplinary team so that surgery, oncology and radiotherapy are coordinated.

Training and experience

Charalambos Charalambous completed a clinical fellowship in colorectal surgery at Manchester Royal Infirmary in the United Kingdom and holds a ChM in General Surgery with Distinction from the University of Edinburgh. More about his training and experience.

Consultations

Consultations are available at the German Medical Institute in Limassol and, on Wednesday afternoons, at the GMI outpatient offices at Zoi Medical Diagnostic Center in Nicosia. Surgical treatment is provided at the German Medical Institute. Contact details and appointments.

Frequently asked questions

When is surgery required for colorectal cancer?

Surgery is the main treatment for most colon cancers and many rectal cancers. Some very early cancers can be removed endoscopically, while for rectal cancer chemotherapy and/or radiotherapy may be given first. The decision is made after staging and multidisciplinary discussion.

What is the difference between colon and rectal cancer surgery?

Colon cancer surgery removes the affected segment of the colon with its lymph nodes. Rectal cancer surgery takes place in the narrow space of the pelvis, close to the sphincter muscles and pelvic nerves; it follows the principles of total mesorectal excision and is more often combined with treatment before surgery and a temporary stoma.

Can colorectal surgery be performed laparoscopically or robotically?

Many colorectal operations can be performed with minimally invasive techniques. Whether this is appropriate depends on the disease and its extent, previous surgery and individual factors, and is discussed before the operation.

Will I need a stoma?

Most patients do not need a permanent stoma. A temporary stoma may be used to protect a join in the bowel, particularly after low rectal surgery, and is usually reversed later. A permanent stoma is needed in selected cases, for example when the lowest part of the rectum and the anus have to be removed. See Intestinal stomas and stoma reversal.

This information is general and does not replace individual medical assessment.