After you come out of surgery, you will stay at the hospital for several days. The length of time you’ll stay depends on a couple factors, including your health history and the type of surgery you had. At the hospital, your healthcare team will monitor you and make sure that you are recovering well.
Initially, you may be hooked up to lots of tubes and wires. You will have nurses and doctors coming in at regular intervals to check on your vital signs and administer medications.
It’s important to note that this section is most relevant for those having lower GI surgery.
When you wake up from surgery, you may have a nasogastric (NG) tube. This tube goes through the nose and into the stomach, and provides you with nutrition without putting stress on your digestive system. After surgery, your intestines will likely be paralyzed, which means that you can’t properly digest anything you eat or drink. So it’s especially important to start eating and drinking slowly to make sure everything is working properly.
First, you will receive all the fluids you need intravenously. When you start to pass gas — also known as farting! — it’s a good sign that your colon is starting to work again. Then, your healthcare team will remove your NG tube and start you on a liquid diet. They may start you off with ice cubes. They will monitor your nausea and abdominal pain levels. If this goes smoothly, then you will progress to a low-residue/low-fiber diet. You should continue a low-residue diet for 2-8 weeks after your procedure, depending on your surgeon’s instructions. This is particularly important if you have an ostomy, in order to prevent dehydration and blockages in the initial weeks after surgery. You can learn more about low-residue diets in our ostomy section.
Within a day or two, you should be able to sit upright and walk short distances. Walking as soon as you can helps with your circulation and encourages your bowels to return to normal. Regular movement will also help your recovery in general. This will be difficult and painful at first, but your nurse is there to support you and make sure that you are moving safely. It is also easier to start walking while your pain is well-managed with medication. After you become more comfortable getting out of bed and moving around, you can start walking independently or with the help of a visitor.
Your team should be able to arrange for a mobility device for you to take home, such as a walker or a wheelchair. They can also refer you to a physical therapist who can visit you in the hospital and at home to help with your recovery
Your healthcare team will give you personalized instructions to follow after surgery. Likely, these instructions will include breathing exercises to prevent respiratory complications like pneumonia. Make sure that you are inflating your lungs completely. It may be painful at first, but these exercises help clear any fluid leftover in the lungs from surgery. Chat with your physical therapist about other types of exercise they recommend.
You will be prescribed pain medication, likely intravenously at first. You will then transition to oral pain meds before you are discharged. If you are feeling uncomfortable, let your healthcare team know.
Your surgeon or nurse will give you instructions on how to care for your incision. Follow these instructions carefully!
Your incision will be dressed with a sterile bandage. Keep this bandage on until it falls off, or until your doctor removes it. You may also have stitches or staples that will fall out on their own, or need to be removed later by your surgeon. Ask your healthcare team which type of sutures you received.
There may be some redness around the edges of your incision. Keep an eye on it and check for infection. If the drainage is green or yellow, or if the skin around the incision is getting increasingly red or warm to the touch, call your doctor.
Make sure to take your pain medication as prescribed. You want to make sure that you are staying ahead of the pain — don’t wait until you are feeling poorly to take your next dose. If you need a refill of your prescription pain medications, be sure to call several days in advance to make sure you receive more before you run out. After checking with your doctor, you may also add ibuprofen (Advil) or acetaminophen (Tylenol) to your pain medication regimen.
A low-grade fever is common after surgery. Your temperature may vary, but if it exceeds 101.5°F or if you are vomiting, have chills or flu-like symptoms, contact your doctor immediately.
Constipation is common after surgery. Taking common prescription pain medications can cause your intestines to move slower. Constipation is less common if you have an ileostomy. You can speak with your doctor about taking a stool softener with your pain medications. You may also try prune juice or milk of magnesium, if your doctor okays it.
Liquid output is common in people with new ileostomies. People with ileostomies can become easily dehydrated, so avoiding liquid output is really important. Ileostomy output should be the consistency of nut butter. If it isn’t thick enough, foods like white rice, bananas, white bread and pasta can help slow down your digestion. If that doesn’t help, contact your team. It may be necessary for you to take anti-diarrhea medications such as Immodium.
Take it easy. Do not do any strenuous activities or lift more than 5 to 10 pounds for at least 4 to 6 weeks after surgery. Just for reference, a gallon of milk weighs over 8 pounds! If you are struggling with returning to physical activity, you can request a referral to a physical therapist to help. You can begin having sex again when you feel ready, usually 4-6 weeks after your surgery. Chat with your doctor about any specific questions you have.
Do not fully immerse yourself in water, like in a bath tub or hot tub. You can shower 24 to 48 hours after surgery, unless your doctor says otherwise. Leave all of your bandages on while showering. Be sure to dry the area very well afterwards.
Don’t drive while taking prescription pain medications. Reach out to family and friends if you need them to run errands for you, or drive you places. After you stop needing pain medications, and you feel ready to get behind the wheel again, you can drive.
You can likely return to work 3 to 4 weeks after a traditional open surgery, and 1 to 2 weeks after a laproscopic surgery. However, this all depends on what kind of work you do. Warehouse work and office work will require different reintroduction plans. Chat with your family, doctor and employer to make a plan.
There are a number of things your team will do after surgery to monitor your cancer. If you live in the US, your oncologist will be guided by the NCCN recommendations for colon and rectal cancer.
If you were diagnosed at stage I, II or III, you will have a colonoscopy one year after your surgery. If the results are normal, you will come back after three years, then every five years after that. If any cancer is found, you will come back more frequently.
If you are stage II or III and having chemo, immunotherapy, or other targeted therapies, you will have scans every 3 months while on treatment, then every 6 to 12 months after finishing treatment for the first 5 years. You will also have a general medical exam, including routine blood work and CEA testing every 3 to 6 months for the first two years, and every 6 months for the next three years after that.
If you were diagnosed at stage IV, you will have scans approximately every three months while on treatment. If you reach NED following surgery, the monitoring recommendations are similar to those for stage II and III patients.
Your healthcare team may also recommend some newer tests, such as Signatera and Guardant Reveal, which test for ctDNA (circulating tumor DNA). They may be able to detect reoccurrence several months before they become visible on scans. For more information, check out our testing Learning Center.
Most people need 6-8 weeks to recover after surgery, and if you need post-surgery chemotherapy, it will usually start around that time. However, the timing depends on your own personal situation and recovery plan. Chat with your oncologist about your treatment timeline for more information.
Diagnosed: November 2018
Type: Rectal cancer with 5/24 positive lymph nodes and two liver mets
Biomarkers: MSS, KRAS, G12D
Treatments: Surgery to remove primary tumor and complete hysterectomy, six treatments of FOLFOX with Avastin, liver resection with gall bladder removal, six treatments FOLFOX with Avastin. Curative intent from the beginning of treatment. After six treatments of FOLFOX with Avastin, referred to a surgical oncologist for open liver resection.
At the first appointment, the surgery date was set up, all pre-surgery bloodwork was ordered and I met with a dietitian that helped me plan for what I should eat following surgery. They gave me a lot of information and I felt well-prepared for the post-surgery challenges, particularly the depressed appetite and extreme fatigue. In anticipation of low energy, I prepared several high-protein, single-serving freezer meals to make it easy to follow the dietitian’s suggestions following surgery. Eating enough was a challenge and I had a pretty limited diet of protein drinks, boiled eggs, and peanut butter on half a bagel, along with the meals I had frozen, to ensure I was getting the protein needed for recovery.
Because I was getting Avastin with chemo, surgery was scheduled for six weeks into my chemo break and chemo was not resumed until seven weeks post-surgery. Two portions of my liver, one in each lobe, were removed, along with my gall bladder. The incision was closed with glue. Pathology confirmed clear margins. The hospital placed a binder around my abdomen that remained on at all times, except when showering. I continued to wear the binder for about 8 weeks following surgery to support my weakened abdominal muscles. Unfortunately, I later developed a hernia at the incision, about six months after the resection, when I started doing exercises, like crunches, to strengthen my abs.
I was given a choice between a nerve block and an epidural for the surgery. I chose the epidural, which meant the catheter remained until 24 hours after the epidural was removed. Overall, the epidural did a good job with pain management in the first couple of days following surgery.
Walking, beginning the day after the liver resection, is so important. Because the fatigue is tough in the first few weeks, I focused on many short walks throughout the day. I had been very active leading up to surgery, walking or running most days, which helped with my recovery. Regular napping was also important in the recovery process. Slowly, I was able to walk longer distances and nap less.
I was in the hospital for five days. My surgeon and two of his nurses checked on me every day. They were so good about answering my questions and making sure I was as comfortable as possible after such a tough surgery. Having confidence in your surgeon is so important and I could not be happier with the care I received from his entire team.
Once home from the hospital, I quickly learned I could not comfortably lay flat. I chose to sleep in a recliner for many weeks, as I just found it easier to get up and down. My husband stayed with me for the first couple of days after I returned home, but I was quickly able to take care of my basic needs.
One thing that surprised me was how much hair I continued to lose after the surgery, especially after being off chemo for so many weeks.
From the beginning of treatments, I asked my mother to be the one to update my family after surgeries and/or treatments. This was so helpful since I did not have the energy to talk to many people.
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