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Small intestine

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Surgery for small intestine cancer

Surgery is the primary treatment for small intestine cancer. Surgery is used to:

  • potentially cure the cancer by completely removing tumours in the small intestine
    • Surgery offers the best outcome for people with small intestine cancer, especially when the cancer can be completely removed by surgery (is resectable).
  • reduce pain or ease symptoms (palliative treatment)

The type of surgery done depends mainly on the size of the tumour, its location, the stage of the cancer and other factors, such as symptoms the tumour may be causing. Side effects of surgery depend on the type of surgical procedure.

Surgical resection

An intestinal resection is surgery to remove part of the small intestine and some nearby tissues. The surgeon makes a cut (incision) in the abdomen and removes the section of the small intestine that contains the cancer and some of the normal tissue on either side of the tumour. The cut ends of the intestine are then reconnected (an anastomosis).

The type of resection surgery done will depend on the size and location of the tumour.

Segmental bowel resection

The surgeon will do a segmental bowel resection for tumours in the lower (distal) part of the duodenum (closer to jejunum), and for tumours in the jejunum and the ileum that are localized or have limited spread. The surgeon removes:

  • the tumour along with a section of the small intestine
  • a margin of normal tissue around the tumour

Some of the mesentery (a fold of tissue that supports the small intestine) and regional lymph nodes may also be removed.

Whipple procedure

Doctors may do a Whipple procedure (pancreaticoduodenectomy) for tumours in the upper (proximal) part of the duodenum (closest to the stomach) or the ampulla of Vater (area where the ducts from the pancreas and liver enter the duodenum). This surgery removes:

  • part or all of the pancreas
  • a section of the lower part of the stomach
  • the duodenum
  • a section of jejunum
  • the gallbladder
  • part of the common bile duct (the duct that carries bile to the duodenum)
  • surrounding lymph nodes

Right hemicolectomy

The surgeon may do a right hemicolectomy to remove tumours in the part of the ileum closest to the large intestine (terminal ileum) that also involve the cecum (where the small intestine joins the large intestine). The surgeon removes the part of the ileum containing the tumour and may also remove the:

  • appendix
  • cecum
  • ascending colon (the part of the colon located along the right side of the abdomen)
  • hepatic flexure (the bend in the colon by the liver)
  • first part of the transverse colon (the part of the colon that lies across the upper abdomen)

The rest of the small intestine is then reconnected to the remaining large intestine.

Surgical bypass

Palliative surgery is done if the intestine is blocked and the cancer cannot be completely removed (is unresectable) because it has spread too far in the abdomen or to other organs, such as the liver or lungs. Palliative surgery is done to relieve symptoms of a blocked (obstructed) intestine caused by a tumour. A surgical bypass allows digested food and fluid in the small intestine to go around (bypass) a tumour in the small intestine. The surgeon may also remove enough of the tumour and nearby intestine to allow digested food to pass through.

See a list of questions to ask your doctor about surgery.


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