Rectal Cancer Surgery in Uberlândia-MG

Rectal cancer may cause rectal bleeding (hematochezia), frequently mistaken for hemorrhoids, changes in bowel habits (persistent diarrhea or constipation), tenesmus (a sensation of incomplete evacuation), narrowing of stool caliber, pelvic pain or discomfort, and unintentional weight loss. Rectal bleeding after age 40, anemia of unclear cause, or a persistent change in bowel habits lasting more than four weeks are warning signs that warrant medical evaluation and colonoscopy.

Diagnosis is confirmed by colonoscopy with biopsy of the lesion. Local staging uses pelvic magnetic resonance imaging (MRI), which assesses the depth of tumor invasion, the distance to the circumferential resection margin, and mesorectal involvement; endorectal ultrasound may complement this assessment in early-stage tumors. Computed tomography of the chest, abdomen, and pelvis investigates distant metastases, and the CEA tumor marker assists in follow-up, without replacing imaging studies and biopsy.

Operative time varies according to the technique used (open, laparoscopic, or robotic), the height of the tumor, and the need to create a stoma, generally ranging from three to five hours. Cases involving more complex pelvic dissection, sphincter reconstruction, or surgery combined with other organs may require additional time. The exact duration can only be estimated after individual evaluation of the case by the responsible surgeon.

Surgery is performed under general anesthesia, frequently combined with regional anesthetic blocks (epidural or abdominal wall blocks) to optimize postoperative pain control and reduce opioid consumption. The choice of anesthetic technique is defined together with the anesthesiology team, taking into account age, comorbidities, and the surgical approach planned for the case.

Hospital stay usually ranges between four and seven days for laparoscopic or robotic surgery, and may be longer for open resections or when complications occur. Enhanced recovery after surgery (ERAS) protocols have reduced this time in many cases, but the exact length depends on clinical progress, the return of bowel function, and adaptation to the stoma, when present.

As with any abdominal and pelvic surgery, there is pain in the immediate postoperative period, managed with multimodal analgesia combining standard analgesics, regional blocks, and, when necessary, opioids at controlled doses. Laparoscopic or robotic access is usually associated with less pain and lower opioid use compared with the open approach, but pain intensity varies from patient to patient.

A urinary catheter is commonly used in the first few days after surgery and, occasionally, a pelvic drain as well; both are removed according to clinical progress. The need for a stoma (ileostomy or colostomy) depends on the height of the tumor in relation to the anal sphincter and the safety of the anastomosis: it may be temporary, reversed in a later surgery after adequate healing, or permanent in very low resections with amputation of the rectum.

With laparoscopic or robotic access, scars are limited to small incisions, generally between 5 mm and 12 mm, distributed across the abdomen, plus a somewhat larger incision for removal of the surgical specimen. With open surgery, the incision is midline and more extensive. When a stoma is present, there is also a corresponding skin opening, which can be closed in a subsequent surgery if the stoma is temporary.

Time off usually ranges between four and six weeks for light activities and may be longer for work requiring physical effort. Patients who require adjuvant chemotherapy may also have a longer return time, depending on their tolerance to systemic treatment. The exact time depends on the surgical approach used, the presence of a stoma, and individual recovery, and should be determined on a case-by-case basis.

As with any pelvic oncologic surgery, there are risks of anastomotic leak, surgical site infection, bleeding, injury to neighboring structures (ureter, pelvic nerves), and urinary or sexual dysfunction. Surgery may be contraindicated in situations of prohibitive anesthetic risk or extensive metastatic disease without prior systemic control; each case is evaluated individually with regard to risks and benefits.

In locally advanced tumors, neoadjuvant chemoradiotherapy before surgery is common, aiming to reduce tumor volume and the local recurrence rate; adjuvant chemotherapy may be indicated based on the final pathologic staging. The decision is made by a multidisciplinary team, including a surgical oncologist, medical oncologist, radiation oncologist, radiologist, pathologist, and nursing staff specialized in stoma care (enterostomal therapy).