Understanding Small Bowel Resection for Small Bowel Cancer: An Informative Guide

Introduction and Terminology

When faced with a diagnosis of small bowel cancer, one of the treatment options your healthcare provider may discuss with you is a procedure known as Small Bowel Resection. A Small Bowel Resection is a surgical procedure that involves removing a portion of the small intestine that contains cancerous cells. This process aims to halt the progression of the disease and protect your overall health.

According to the National Cancer Institute, Small Bowel Resection is one of the most commonly recommended treatments for small bowel cancer in the United States, highlighting its widespread use and efficacy.

It’s important to become familiar with some key terms. The ‘small bowel’ or ‘small intestine’ is a part of the digestive system that connects the stomach and the large intestine. ‘Resection’ refers to the surgical removal of part of an organ or structure. Hence, ‘Small Bowel Resection’ means the removal of a portion of the small intestine.

Indications for Small Bowel Resection

The primary indication for Small Bowel Resection is the presence of small bowel cancer. However, there are several specific circumstances under which this procedure may be recommended:

• Localized Small Bowel Cancer: The cancer is confined to a specific area within the small intestine, making it feasible for removal through surgery.
• Advanced or Metastatic Small Bowel Cancer: In some cases, a Small Bowel Resection may be performed even if cancer has spread to other areas, as a method of symptom relief or as part of a comprehensive treatment plan alongside chemotherapy or radiation.
• Recurrent Small Bowel Cancer: If cancer reappears after initial treatment, a Small Bowel Resection may be considered to remove the recurrent cancer cells.
• Prevention of Complications: In certain scenarios, the procedure might be suggested to prevent potential complications, such as intestinal blockage or severe bleeding.

It’s important to note that the choice of treatment is highly individualized and depends on various factors, including the stage and location of cancer, overall health status, and personal preferences. It’s recommended to have an in-depth discussion with your healthcare provider to determine if Small Bowel Resection is the right choice for you.

Pre-Operative Preparation

Proper preparation before your Small Bowel Resection can significantly aid your recovery. Your healthcare provider will give you specific instructions, but general guidelines include:

• Fasting: Usually, you’ll be asked to refrain from eating or drinking for a certain number of hours before the procedure.
• Medication Adjustments: You may need to stop or adjust some of your medications before surgery, so it’s essential to discuss all medications, including over-the-counter drugs and supplements, with your doctor.
• Pre-Op Labs and Imaging: Some tests, like blood tests or imaging studies, may be needed to assess your health status before surgery.
• Pre-Clearance Authorization: Insurance pre-clearance is typically required for surgical procedures.
• Transportation and Time Off: Arrange for transportation after the procedure and ensure you have enough time off work or school to recover.

Please note that these guidelines may vary based on individual circumstances.Always follow the specific instructions given by your healthcare provider. Our telemedicine primary care practice can assist with pre-operative clearances and ordering of pre-op labs and imaging to make this process smoother for you. Please reach out to us for further assistance.

Procedure Technique for Small Bowel Resection

Undergoing a Small Bowel Resection might seem daunting, but understanding the steps involved can help alleviate some of your concerns. This procedure is performed by a surgical team led by a specialized surgeon. Here’s a simplified step-by-step breakdown of what typically happens during a Small Bowel Resection:

Anesthesia

Your procedure begins with the administration of anesthesia to ensure you feel no pain during the operation. This is typically general anesthesia, which means you’ll be unconscious throughout the procedure.

Incision

The surgeon will make an incision (a surgical cut) in your abdomen to access the small intestine. There are two main approaches:

• Open Resection: This involves a single, long incision in the middle of your abdomen.
• Laparoscopic Resection: Instead of one large incision, several small incisions are made. A long, thin tube with a camera (laparoscope) is inserted through one incision, allowing the surgeon to see and operate inside your abdomen via video guidance.

Resection

Once the surgeon has visual access to the small intestine, they locate the portion containing the cancer. This part of the small bowel is then carefully separated from the surrounding tissues and removed. Healthy tissue around the cancer is also typically removed to ensure no cancer cells are left behind.

Anastomosis

After the removal of the cancerous part, the two remaining ends of the small bowel are reconnected. This is known as an anastomosis. In some cases, if a large part of the intestine has been removed or the bowel needs time to heal, the surgeon might create a temporary or permanent stoma. A stoma is an opening in the abdomen that allows waste to be expelled into a bag.

Closure

Finally, the incision (or incisions in the case of a laparoscopic procedure) is carefully closed with sutures, staples, or surgical glue. A dressing is applied to protect the wound and aid in healing.

It’s important to note that every individual’s situation is unique, and the exact procedure may vary based on your specific case and your surgeon’s judgment. Your healthcare provider will be able to provide more personalized details about what to expect during your procedure.

Overall, Small Bowel Resection is a complex procedure that requires a highly skilled surgical team. By understanding the process, you can be better prepared for your surgery and be a more informed participant in your healthcare journey. Remember, it’s okay to ask questions. Your healthcare team is there to help you through every step of the process.

Duration of Small Bowel Resection

A Small Bowel Resection usually takes between two to four hours to complete. The precise duration depends on individual circumstances, such as the size and location of the tumor, and the specific surgical technique used.

Post-Operative Recovery from Small Bowel Resection

After your Small Bowel Resection, the hospital stay usually ranges from five to seven days, depending on your overall health and recovery progress. During your hospital stay, the medical team will monitor your vital signs, pain levels, and the function of your bowel. It’s normal to feel discomfort in the days following the procedure, and pain management will be a key aspect of your care.

Typically, a follow-up appointment with your surgeon is scheduled about two weeks after your discharge. This allows your doctor to monitor your recovery progress, manage any post-surgical complications, and discuss the pathology report with you. Further follow-ups may be scheduled as needed.

Physical therapy is usually not required after a Small Bowel Resection. However, a slow and steady increase in walking and daily activities is encouraged. Depending on your job, you may need to take several weeks off work. Full recovery often takes six to eight weeks, although this can vary based on individual circumstances.

Lifestyle changes may include adopting a more nutritious diet and regular exercise to promote healing and overall health. If a stoma was created during the surgery, you’ll receive specific training on how to care for it.

At our practice, we offer same-day appointments up until 9 pm on weekdays and 5 pm on weekends, so we’re here when you need us, whether that’s for follow-up care or to provide a work or school note.

Effectiveness of Small Bowel Resection

Small Bowel Resection is highly effective for treating localized small bowel cancer. According to the American Cancer Society, localized small bowel cancer patients who undergo surgery have a five-year survival rate of about 83%. This means that five years after the surgery, approximately 83% of these patients are still alive.

The effectiveness of the procedure can be influenced by several factors. The stage of the cancer at the time of surgery plays a significant role. Early-stage cancers that are confined to the small bowel tend to have better outcomes. Additionally, the patient’s overall health can impact the success of the surgery and recovery.

However, there are circumstances where the effectiveness may be lower. If the cancer has spread to other parts of the body (metastatic cancer), a complete cure may not be possible with surgery alone. In such cases, Small Bowel Resection may be used to relieve symptoms, and other treatments like chemotherapy or radiation therapy may be recommended in conjunction with surgery.

It’s important to have an in-depth discussion with your healthcare provider to understand the potential benefits and limitations of Small Bowel Resection in your specific situation.

Adverse Events with Small Bowel Resection

As with any major surgical procedure, Small Bowel Resection can have associated adverse events. These include:

• Bleeding (2-4%): This can occur during or after surgery, potentially requiring a blood transfusion or additional surgery to stop it. Bleeding occurs when blood vessels are inadvertently damaged during the procedure.
• Infection (15-20%): This could be a wound infection, where the surgical incision becomes infected, or an internal abdominal infection. Both are usually treatable with antibiotics.
• Deep Vein Thrombosis (1-2%): This condition involves the formation of blood clots in the deep veins of the leg, which can potentially travel to the lungs, causing a pulmonary embolism. This is a serious complication, but preventative measures are usually taken.
• Adhesive Small Bowel Obstruction (10-20%): This is where the bowel becomes blocked by scar tissue formed after surgery. It may cause abdominal pain, nausea, and vomiting. In severe cases, it might need further surgery.
• Anastomotic Leak (2-4%): This refers to a leak from the site where the bowel was rejoined, potentially leading to an internal infection.

The mortality rate associated with Small Bowel Resection is low, generally around 2-3%, but can be higher in individuals with significant other medical conditions.

Alternatives to Small Bowel Resection

While Small Bowel Resection is a common treatment for small bowel cancer, alternatives do exist. These include:

• Radiation therapy: High-energy radiation is used to kill cancer cells. This may be used when surgery isn’t an option or in conjunction with surgery to ensure the removal of all cancer cells.
• Chemotherapy: This treatment uses drugs to kill cancer cells throughout the body. It can be used before surgery to shrink tumors, after surgery to kill remaining cells, or as the main treatment if surgery is not an option.
• Targeted therapies: These are newer treatments that target specific characteristics of cancer cells, like a protein that allows the cancer cells to grow at a rapid rate.
• Immunotherapy: This treatment approach uses the body’s immune system to fight cancer.

Experimental or Emerging Technologies

There is ongoing research to develop new treatments for small bowel cancer. One emerging technology is CAR T-cell therapy, which involves modifying the patient’s immune cells to fight cancer. Another is the use of nanotechnology for targeted drug delivery, which could potentially increase the effectiveness of chemotherapy and reduce side effects. However, these are still in the experimental stages and not yet widely available.

Conclusion

A Small Bowel Resection is a major surgical procedure used to treat small bowel cancer. While it’s often effective, it also carries some risk of adverse events. Alternatives to this surgery include radiation therapy, chemotherapy, targeted therapies, and immunotherapy. Emerging technologies are also on the horizon. It’s important to have a comprehensive discussion with your healthcare provider to understand all your treatment options and make an informed decision.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.