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Cancer of the descending colon, or of the bend high on the left near the spleen, is removed by a left hemicolectomy or an extended operation. This page explains that robotic operation: which segment goes for which tumour, why the bend near the spleen is usually freed, how the nerves on the left side are kept, how the join is made, and what the first week looks like. Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad.
Last updated: 9 October 2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Robotic Cancer Surgeon (GI)
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
★★★★★ Google: 4.9 from 53 reviews (Gota clinic) · 5.0 from 25 reviews (Apollo, Bhat)
Shah’s Gastro, Cancer & Robotic Surgery Centre. Super-specialty training in surgical gastroenterology, two higher degrees in it, and 18 years of experience in GI and cancer surgery. Every colon cancer is discussed at the tumour board once staging is complete, and Dr Harsh Shah performs the operation himself.
In short
Cancer of the descending colon is treated by a left hemicolectomy: the segment is removed with the fatty fold that carries its vessels and lymph nodes, and the left colic vessels are tied where they arise. A tumour at the bend near the spleen needs an extended operation, chosen on the scans.
For the remaining colon to reach the join without tension, the bend near the spleen is usually freed from the spleen, the stomach and the tail of the pancreas. High under the left ribs, that is where the robot’s wristed instruments and steady view help most.
On the left side the nerves for bladder and sexual function lie close to the main vessels, and they are found and kept. The join is checked for blood supply with a glowing dye, and the specimen usually comes out through a short cut low on the abdomen.
The left colon runs from the bend near the spleen, called the splenic flexure, down the left side of the abdomen as the descending colon, to the sigmoid colon in the pelvis. Where the tumour sits on that path decides the segment removed and the vessels tied.
| Where the tumour is | Operation | Vessels tied at their origin | The join |
|---|---|---|---|
| Descending colon | Left hemicolectomy | The left colic vessels | Remaining colon to the sigmoid or the top of the rectum |
| Splenic flexure or the far end of the transverse colon | Extended left hemicolectomy, or extended right hemicolectomy, chosen on the scans | The middle colic vessels, with or without the left colic | Depends on the operation chosen |
| Sigmoid colon | A different operation (sigmoid colectomy or anterior resection) | Explained separately | Explained separately |
A tumour at the splenic flexure sits where two blood supplies meet, so its lymph nodes can drain either way. The tumour board looks at the CT to decide whether an extended left or an extended right operation removes the right nodes with the least bowel.
This page covers the descending colon and the splenic flexure. Cancer of the sigmoid colon is removed by a different operation, and cancer of the rectum by the operations described on this site’s rectal cancer pages.
After the diseased segment is removed, the colon above it must reach the join lying loosely, without being stretched. On the left this usually means freeing the splenic flexure: releasing the colon from the spleen, the stomach and the tail of the pancreas so it can swing down.
A join under tension heals poorly, and a leak at the join is the complication surgeons most want to avoid. Freeing the flexure is the main step that prevents tension, which is why it is part of most left hemicolectomies, not only for tumours at the flexure itself.
The flexure lies high under the left ribs, beside the spleen and the tail of the pancreas. The tissues there are thin and the spleen bleeds easily if pulled, so the dissection is done by sharp, gentle division rather than by tearing, opening the space behind the stomach and releasing the ligament that ties the colon to the spleen.
In a few patients the colon is long enough to reach without freeing the flexure. The surgeon decides on the table, after seeing how the bowel lies.
The extent of the operation does not change with the robot. What it adds on the left side is a steady, magnified three-dimensional view and wristed instruments in the two hardest places: high under the ribs at the splenic flexure, and low at the root of the main vessels where the nerves run.
There is no sense of touch through the robot’s instruments, so a small tumour is located by the ink tattoo placed beside it at colonoscopy, and margins are judged by sight and on the scans.
The patient lies on the back with the legs supported apart, so the bowel can be reached from below for the join. The table is tilted head-down and right side down, so the small bowel falls away to the right. The ports mirror those of a right-sided operation.
The robot is docked so that its arms reach the root of the vessels first, then the splenic flexure high on the left. The arms can be re-aimed between these two areas; when the flexure is very high, the approach is planned before the operation so that undocking is avoided.
At the end the specimen comes out in a bag through one short cut, usually low across the abdomen, which is less painful and less likely to develop a hernia than a cut through the middle.
The operation starts at the vessels and works outwards: the vessel root is tied, the fatty fold is lifted off the back wall in its natural plane, the splenic flexure is freed, the bowel is divided with clear margins, and the two ends are joined.
Most left hemicolectomies end with a join and no stoma. A temporary ileostomy is added only when the join is judged less secure, for example when the blood supply is borderline, the patient is frail, or the bowel was blocked before surgery.
The join is tested at the end of the operation. If there is any doubt, the safer choice is to protect it with a temporary ileostomy, which is closed a few months later once the join has healed. A stoma nurse marks a possible site before every colon operation, even though most patients will not need it.
Whether to close the gap in the mesentery after the segment is removed is decided by the surgeon on the table.
All three remove the same segment, the same fatty fold and the same lymph nodes. Keyhole surgery is the established standard. They differ most at the splenic flexure and the vessel root, in the size of the cut, and in the speed of recovery.
| Open | Keyhole | Robotic | |
|---|---|---|---|
| Cut | A long cut on the abdomen | Ports and a short cut | Ports and a short, usually low cut |
| Reaching the splenic flexure | A longer cut upwards | Steep angle, straight instruments | Wristed instruments, steady magnified view |
| Nerves at the vessel root | Seen directly | Magnified | Magnified, three-dimensional |
| Blood-supply check | By eye | Dye where available | Dye built into the camera |
| Blood loss | Higher | Lower | Lower |
| Lymph nodes removed | The same | The same | The same |
| Hospital stay and return to work | Longest | Shorter | Shorter |
| Cost | Lowest | Similar to open | Higher, for the robotic instruments |
When to return to work and to lifting depends on the job and on the cut, and is planned with you at discharge.
A left-sided cancer sometimes first shows itself as a blockage. In a fit patient the segment is removed and joined, sometimes with a temporary stoma, or the end is brought out as a stoma to be rejoined later. In a frail patient, or one with spread elsewhere, a stent placed through a scope can relieve the blockage and avoid an emergency stoma.
A stent can be a bridge to a planned operation a few weeks later, once the patient has recovered and the bowel has been prepared, or it can be the treatment in itself when an operation would not help. The choice is made at the tumour board, or on the day for an emergency.
Open surgery is chosen for a bulky tumour grown into neighbouring organs that needs a larger en-bloc removal, or for an abdomen scarred by several previous operations. If bleeding is not controlled at once or the plane is lost, a robotic operation is converted, and that is part of the consent.
Most patients are up on the day of surgery, eating normally from the next day and walking several times a day, with no tube through the nose and usually no drain. Home is usually around the fourth or fifth day after an uncomplicated operation.
| When | What happens |
|---|---|
| Day of surgery | Sitting out of bed a few hours after the operation; clear fluids; chewing gum; pain relief with minimal opioids |
| Next day | Normal diet as tolerated; walking four times; catheter out; drip off |
| Second day | Full diet; tablets for pain; passing wind |
| Third day | A bowel action; drain out if one was placed; discharge criteria reviewed |
| Fourth or fifth day | Home once eating, walking and pain on tablets are steady, and stoma care is learnt if a stoma was made |
Warning signs are acted on the same day: a fast pulse, fever or worsening abdominal pain between the third and seventh days can mean a leak at the join and is investigated at once with a scan. Pain in the flank or very little urine is checked for a problem with the ureter. Bloating with vomiting may be a slow bowel.
These complications, and the figures that apply to your operation, are discussed at the consent visit.
The pathology report is discussed at about two weeks. It states the lymph nodes examined, the margins, the mismatch-repair result and any high-risk feature, and these decide whether chemotherapy is advised. If it is, it starts within six to eight weeks of the operation.
A tumour with a mismatch-repair defect leads to an offer of genetic counselling, because it can run in families. How colon cancer is first found and staged is explained on the colon cancer pages of this site.
| When | What is checked |
|---|---|
| At two weeks | The wound, the pathology report, the chemotherapy referral if needed, stoma review, and the dietitian |
| Every three months for three years | Symptoms, weight, examination and the tumour-marker blood test |
| Every six months in years four and five | The same |
| Yearly | A CT scan of the chest, abdomen and pelvis |
| At one year | Colonoscopy, then at three years, then every five years if normal |
★★★★★
“I had a truly positive experience with Dr. Harsh Shah. He is not only highly knowledgeable but also very compassionate and patient in explaining every detail. I underwent CRS HIPEC surgery under his care, and I couldn’t have asked for a better doctor. The entire process was smooth, and his expertise made a complex procedure feel manageable. Post-surgery recovery was well-monitored, and he was always available for any concerns. Highly recommend Dr. Harsh Shah for anyone needing advanced surgical oncology care.”
— Akram Khan, Google review, Robotic Cancer Surgery in Ahmedabad listing
★★★★★
“Excellent doctor for stomach cancer. We r very happy. Recommend for gastro cancer treatment in Ahmedabad”
Purshottam Meena · Google review
★★★★★
“Dr harsh operated my sister for liver cancer .we came for follow up .Now she is good. Thank u so much sir”
Natu Vadalia · Google review
Quoted exactly as written on the centre’s Google listings: a family whose relative had robotic surgery for colon cancer, and two patients of Dr Harsh Shah treated for other cancers, followed by a patient speaking after colon cancer surgery.
A robotic left hemicolectomy costs more than an open or keyhole one, because of the robotic instruments and staplers. An extended operation, a temporary stoma and its closure, a longer stay or a complication change the total. The office prepares a written estimate once the plan is set.
Cashless admission is arranged at Apollo Hospital, Bhat where your policy allows it, and the office prepares the pre-authorisation papers; allow a day or two for robotic approval. Ask whether your policy covers robotic surgery and up to what limit. Bring the policy documents, photo identity, every report with the scans on disc, and a list of current medicines.
The bend of the colon high on the left, beside the spleen. It is usually freed so the remaining colon reaches the join without tension.
Most patients do not. A temporary ileostomy is added only if the join is judged less secure, and it is closed a few months later.
Yes. They run close to the main vessels on the left and are identified and preserved unless the cancer involves them.
No. Keyhole is the established standard and the robot is used where it helps. Bulky tumours stuck to other organs, or a scarred abdomen, are operated open.
In a fit patient it is removed and joined, sometimes with a stoma. In a frail patient a stent can relieve the blockage first.
Within six to eight weeks of the operation, once the pathology report has been discussed.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of scans and pathology reports, second opinions, follow-up and surveillance.
Google: 4.9 · 53 reviews
Apollo Hospital, Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Google: 5.0 · 25 reviews
Patients travel for colon cancer surgery from across Gujarat, southern Rajasthan and western Madhya Pradesh.
Send the colonoscopy report, the biopsy report and the CT report ahead of your appointment, so the consultation starts with them already read. Which operation you need, and whether it is robotic, keyhole or open, is decided at the consultation after examination, and by the tumour board. Call +91-63590-11009 WhatsApp the office
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