Do’s and Don’ts for surgery for colorectal cancer

18 Jan, 2022

Preparation before surgery

• Smoking and alcohol: Should be preferably stopped. Medical help or even nicotine chewing gums may be sought to reduce the craving and help avoid smoking. Cessation of smoking even for 2-3 days prior to surgery helps, although a longer duration helps reduce respiratory complications after surgery.
• Activity: “The more the better” is the mantra. All attempts should be made to ensure patient does brisk walking and continues to do all activities of daily living.
• Nutrition: Patients should continue taking diet as usual. Some patients would be told to take a liquid diet or even bowel preparation before surgery depending on site of tumour and symptoms. If constipation or abdominal pain is the presenting symptom, taking a low residue diet, essentially comprising dairy, some protein supplements, and a dominantly liquid diet would help manage symptoms and prepare better for surgery. Nutritionmust be maintained and at least a protein rich liquid diet should be tried.
• Chest exercises: Deep breathing, and incentive spirometry (a small lowcost appliance through which the patient takes deep breaths and tries to hold the breath) helps build up respiratory reserve for surgery. This helps patients recover better and faster after anesthesia and surgery.
• Sphincteric exercises: There is a natural sphincter at the end of the digestive tract which helps ensure continence (ability to control the passage of stool or gas from the digestive tract). Doing sphincteric exercises helps ensure that this continence mechanism is preserved at surgery. The best way to do these exercises is to sit on a chair, bend a little forward and pull in the anus for as long as possible while continuing to breathe. It takes some time to learn thisanpersistent efforts do help. The longer the patient can hold while continuing to breathe the better it is for post-operative functional outcomes.
• Taking care of other co-existing illnesses
  • DM, Hypertension, Hypothyroidism: Significant proportion ofpatients would have coexisting illnesses. Patients with adequately managed co-existing illnesses do better and face less complications. Appropriate consultation with primary care providers should be sought as needed to help optimize for these conditions.
  • Blood thinners: Low dose aspirin (ecosprin) would largely be continued till a day prior to planned colonoscopy and surgery

Early postoperative phase

• Don’t be in bed for long. Early patient mobilization has shown to hasten recovery. As a minimum, regularly moving feet and legs and even wriggling of toes is important to prevent clots forming in the leg veins which can be life threatening.
• Early feeding if surgeon/physician allows
• Deep breathing and using a spirometer or a respirometer tha6t is best started prior to surgery and continued post-operatively helps reduce postoperative respiratory infections.

Late postoperative phase (Adapting to the ‘new normal’ diet)

Each patient will have a different recovery experience based on the extensiveness of their surgery and other health factors. Bowel habits after colon resection may be altered for several monthsmore so if patient needs chemotherapy after surgery. Follow these guidelines for the first few weeks after your surgery. This will help keep you comfortable while your colon heals.

• Avoid eating 3 big meals, rather try having 6 small meals. You’ll digest them easier, and bloating would be less
• Don’t drink too much liquid with the meals as it will push the food through the bowel too quickly and enough digestion /absorption may not happen. Drink most of your liquids at least an hour before or after a meal.
• Start with soft foods like cooked vegetables, bananas, mashed potatoes, and tender proteins. A low-fibre bland diet (low-residue) for 4 to 6 weeks can help. Obese and/or diabetic patients would be advised a low fat high protein diet
• When a part of your bowel/colon is removed, it takes time for the remaining bowel to adapt and start absorbing nutrients and liquids. You may need some vitamin supplements during this phase. Patients undergoing removal of right side of colon should take Vitamin B12 oral supplements (1500 mg B12 twice weekly) lifelong.
• Large intestine helps absorb water for the digested meal. Because the large intestine is now relatively shorter, digested food doesn’t have as far to travel (or as much time to form into solid stools) before it leaves your body. Diarrhoea is common after large bowel resection. Spicy food and liquids containing sugarscan make diarrhoea worse, and avoiding these helps reduce stool frequency. This usually settles with time, sometimes requiring medicines (antimotility agents) under the supervision of your doctor.