Types of surgery

The type of surgery you have will depend on where your cancer is, what size it is and whether it has spread to other parts of the body. If your cancer has spread outside the colon or rectum, read our information on treatments for advanced cancer. 

This page describes surgery for colon and rectal cancer, stomas, open and keyhole surgery, and surgery for a blocked bowel. 

Treatment before surgery  

Before surgery, you may need treatment to shrink the tumour. This gives the surgeon the best chance of completely removing the cancer. You may have radiotherapy, chemotherapy or both treatments. This is called neoadjuvant treatment. You may be more likely to have neoadjuvant treatment if you have rectal cancer.  

Surgery for colon cancer

 Local resection

If you have a very small, early-stage cancer, the surgeon may remove it from the lining of the bowel without needing to make a cut in your stomach area (abdomen). Instead, they use a flexible tube with a light at the end, called a colonoscope or sigmoidoscope. They pass the tube into your bottom (anus) and up into your bowel. They then pass instruments through the tube to remove the cancer from the colon. 

Common types of surgery for colon cancer 

The most common types of surgery are described here. Your healthcare team can give you more information about the type of surgery you will have or have had. 

The surgeon will remove the part of the colon that contains the cancer and the nearby lymph nodes. This is called a colectomy. The surgeon joins the remaining ends of colon together using stitches or staples. The join is called an anastomosis. 

The pictures show which parts of the bowel (shaded yellow) are removed in each type of surgery. 

A right hemicolectomy removes the right half of the bowel. If the cancer is in the middle section of the colon, your surgeon may also remove the middle section of colon. This is called an extended right hemicolectomy. If the cancer is in the left side of the colon, you will have a left hemi-colectomy.  

Other types of surgery 

These operations aren’t common and are usually only offered to people who have more than one cancer in their bowel or who have a genetic condition, such as familial adenomatous polyposis (FAP) or Lynch syndrome. 

A total colectomy removes the whole colon, leaving the rectum in place. You may have a permanent ileostomy or your small bowel may be joined to your rectum.  

A proctocolectomy removes the colon and the rectum. 

A panproctocolectomy removes the colon, rectum and anus. You’ll have a wound where the anus has been closed. Avoid putting pressure on this wound while it heals. You’ll need to lie on your side in bed and sit on a pressure-relieving cushion. 

Some people may have more operations to make a pouch from the end of the small intestine. This stores bowel movements before you go to the toilet. This is called an ileoanal pouch. 

If you can’t have an ileoanal pouch, you’ll have a permanent stoma (ileostomy). 

Stomas 

If you have bowel surgery you may need to have a stoma. This is an opening on your stomach area (abdomen) where a section of bowel is brought out. Poo (waste) is collected in a bag attached to the skin around your stoma.  

You can find out more on our stoma webpage. 

Surgery for rectal cancer

Transanal surgery 

If you have a small, very early rectal cancer or if you can't have major surgery, your surgeon may offer you a local resection. This is called transanal endoscopic mircosurgery (TEMS) or transanal minimally invasive surgery (TAMIS). 

The surgeon passes the surgical instruments through your bottom (anus) so you will not have any cuts in your stomach area (abdomen). The surgeon uses the instruments to remove the cancer and the surrounding healthy tissue.  

If the surgeon can't remove the cancer this way, they may need to switch to keyhole or open surgery. If there is a chance of this happening, your surgeon will tell you before your operation.  

Transanal surgery is not available in every hospital. You can ask your healthcare team to refer you to another centre if they think it would be suitable for you. 

Total mesorectal excision 

Surgeons use TME to treat cancers in the middle or lower rectum. You’ll have a TME as part of a low anterior resection or an abdomino-perineal resection.  

For this surgery, the surgeon removes: 

• the part of the rectum where the cancer is  

• the surrounding fatty tissue 

• the envelope of tissue that contains lymph nodes and blood vessels (mesorectum)  

This lowers the risk of the cancer coming back after treatment.

Anterior resection 

This operation removes all or part of the rectum or sigmoid colon. Depending on where the cancer is, you may have a high anterior resection or a low anterior resection.  

You may need to have a reversible stoma for a few weeks or months to allow the join in the rectum to heal. 

For cancers in the lower part of the rectum, the surgeon will remove most of the rectum. They will join the end of the colon to the anus. This join is called a coloanal anastomosis. Not everyone can have a coloanal anastomosis. Speak to your surgeon about the benefits to you and how it may affect your bowel function.  

Sometimes the surgeon uses the end of the colon to make a pouch, called a coloanal pouch. This acts like the rectum to store bowel movements before you go to the toilet. 

 Abdomino-perineal resection 

If the cancer is very low down in the rectum, your surgeon will need to remove the rectum and anus. This operation is called abdomino-perineal resection/excision of the rectum (APER).  

After surgery, you’ll have a permanent stoma (colostomy). You’ll also have a wound where the anus has been closed. Avoid putting pressure on this wound while it heals. You’ll need to lie on your side in bed and sit on a pressure-relieving cushion.  

Your pathology report 

After surgery, your healthcare team will know more about:  

• whether they were able to remove all the cancer 

• how far the cancer has spread  

• whether you need more treatment  

• whether the cancer is linked to an inherited condition 

A doctor called a pathologist will look at the cancer cells under a microscope to see how normal or abnormal they look. This is called grading the cancer and it can help to show whether the cancer is likely to spread and how quickly.  

Your doctor will also stage the cancer. This involves describing the size of the cancer, where it is and whether it has spread.  

You can find out more about tumour grading and staging here. 

Surgery for locally advanced cancer 

Locally advanced bowel cancer is when cancer has spread into tissues next to the bowel, such as the bladder or nearby lymph nodes. 

In women, cancer may spread to the uterus and vagina. In men, it may affect the prostate.  

If you have locally advanced bowel cancer, your healthcare team will explain your treatment options to you.  

They may offer you surgery to remove the cancer from the bowel and any other affected organs. This is called pelvic exenteration. The team will explain the benefits and risks of surgery. You can find out more about this type of surgery on the pelvic exenteration webpage. 

If you decide to have surgery, you’ll have your operation at a centre that specialises in this type of operation. A team of doctors will carry out the operation. This may include a colorectal surgeon, urologist, gynaecologist and plastic surgeon. 

There are different ways you can have surgery

Your surgeon may offer you a choice of keyhole (laparoscopic) surgery, robotic-assisted or open surgery. The way your operation is carried out will depend on lots of factors, including where your cancer is, whether it has spread to other parts of the body and your general health. 

Your healthcare team will offer the best and safest option for you. Speak to your healthcare team if you have any questions about your surgery. 

Keyhole surgery

If your operation is planned, your surgeon is likely to offer you keyhole surgery. This is sometimes called laparoscopic surgery or minimally invasive surgery. 

Keyhole surgery involves making several small openings in the stomach area (abdominal wall). The surgeon removes the tumour using surgical instruments, guided by a camera.  

Advantages 

Compared with open surgery, the advantages of keyhole surgery include: 

• less pain after surgery 

• lower chance of complications after surgery, such as infection 

• lower chance of needing a blood transfusion 

• a shorter hospital stay 

• faster recovery 
   

Disadvantages 

Compared with open surgery, the disadvantages of keyhole surgery include: 

• not being suitable for all rectal cancers 

• a longer operation than open surgery 

• not being suitable if you are very overweight, if you have had abdominal surgery before or if the tumour is large 

• the surgeon may need to switch to open surgery during the operation 

Robotic-assisted surgery 

Robotic-assisted surgery (RAS) is a new type of minimally invasive surgery. The surgeon makes a few small openings in the stomach area (abdomen) and uses a surgical robotic system to help remove the tumour. The robotic system has four arms that hold a camera and the surgical tools. It allows the surgeon to see the operation in 3D. A surgeon controls the robotic system from the surgeon console, which is in the operating theatre. Their team helps with the operation. Robotic-assisted surgery is not available in all hospitals in the UK yet but it’s becoming more common. 

Not everyone can have robotic-assisted surgery. Your healthcare team will talk to you about which surgery is best for you.  

Some evidence shows that it has similar benefits and risks to keyhole surgery. This could mean a shorter stay in hospital and a faster recovery time compared to open surgery, but doctors are still studying the long-term outcomes. It may be an option for some people who can’t have keyhole surgery, such as people who are very overweight. 

Speak to your healthcare team if you have any questions about your surgery.  

It's important to understand that the robotic system doesn't perform your procedure. Your surgeon will be carrying out the operation alongside their team and will be in control of your operation the whole time. 

You can find out more about robotic-assisted surgery in our factsheet or our video below. 

Open surgery 

In open surgery, the surgeon will make one opening in the stomach area (abdomen). 

Your surgeon may recommend open surgery if: 

• the tumour is large or difficult to access 

• you have had abdominal surgery before 

• you're very overweight 
   

Advantages 

Compared with keyhole surgery, the advantages of open surgery include: 

• the surgeon directly seeing and feeling what they're doing, which may make the operation more straightforward 

• a shorter operation time 
   

Disadvantages 

Compared with keyhole surgery, the disadvantages of open surgery include: 

• a larger wound that takes longer to heal 

• a higher chance of a wound infection and part of the bowel pushing through the wound (hernia) 

• a longer hospital stay 

• a longer recovery time 

Emergency surgery for a blocked bowel

Sometimes cancer can block the bowel, stopping poo from passing through. This is called bowel obstruction. It can cause pain, bloating and being sick (vomiting). If this happens you’ll need treatment as soon as possible and you may need an operation. 

If you need surgery, the surgeon may:  

• create a stoma  

• remove the affected part of bowel  

• put in a hollow, expandable tube called a stent  

Creating a stoma  

The surgeon may create a stoma above the blockage, to divert bowel movements out of the body. This gives you time to have tests and any other treatment before surgery to remove the cancer. 

Removing the blockage  

If the surgeon removes the blocked part of the bowel, you may need a reversible or permanent stoma afterwards. 

If re-joining the bowel is too risky and the blockage or damage is in the left side of the bowel, your surgeon may remove the sigmoid colon and the top part of the rectum. This is called Hartmann’s procedure. You’ll have a stoma, which is usually permanent but may be reversible in some cases. Your rectum and anus will still be in place. 

Putting in a stent  

Stents are sometimes used to treat blockages in the large bowel (colon). The stent relieves symptoms of the blockage by holding the bowel open so that poo can pass through. The stent stays inside your bowel. You may have another operation later to remove the cancer. 

More information 

• Our health information booklet 'Your operation' has more information on bowel cancer surgery 

• Cancer Research UK has more information on bowel cancer surgery 

• Macmillan Cancer Support has more information on surgery for colon cancer and rectal cancer 

• Association of Coloproctology of Great Britain and Ireland provides information on bowel cancer surgery. 

Updated May 2025 

Next review May 2028