Surgery for cancer in the rectum
There are different types of operations for cancer in the rectum. The type of operation you have depends on where the cancer is located, whether the bowel can be rejoined, and where in the rectum the join can be made.
The surgery may be performed using an open or keyhole approach. You may have an anterior resection or abdominoperineal resection (also known as an abdominoperineal excision).
This is the most common operation. It may include creating a temporary stoma, which will be reversed later.
This procedure may be recommended if the cancer is near the anal sphincter muscles or if it is too low to be removed without causing incontinence (accidental loss of faeces). After an abdominoperineal resection you will need a permanent stoma (colostomy). Speak to your surgeon about any concerns you may have.
Types of resections
High anterior resectionThe surgeon removes the lower left part of the colon and the upper part of the rectum. Nearby lymph nodes and surrounding fatty tissue are also removed. The lower end of your bowel is rejoined to the top of the rectum.
Abdominoperineal resection or excision (APR or APE)The sigmoid colon, the entire rectum and the anus are removed. Your surgeon uses the descending colon to create a permanent stoma (known as a colostomy) for faeces to leave the body. The anal area will be stitched up and permanently closed.
Ultra-low anterior resectionThe lower left part of the colon and the entire rectum are removed, along with nearby lymph nodes and fatty tissue. The end of the bowel is joined to the lowest part of the rectum, just above the anus. In some cases, the surgeon creates another way for waste to leave the body (see below).
Colonic J-pouchAn internal pouch is made from the lining of the large bowel. This J-pouch will be connected to the anus and work as a rectum. You may have a temporary ileostomy (a stoma from the small bowel), which will be reversed once the J-pouch heals.
A/Prof Craig Lynch, Colorectal Surgeon, Peter MacCallum Cancer Centre, VIC; Prof Tim Price, Medical Oncologist, The Queen Elizabeth Hospital, Adelaide, and Clinical Professor, Faculty of Medicine, The University of Adelaide, SA; Department of Dietetics, Liverpool Hospital, NSW; Dr Hooi Ee, Gastroenterologist, Sir Charles Gairdner Hospital, WA; Dr Debra Furniss, Radiation Oncologist, Genesis CancerCare, QLD; Jocelyn Head, Consumer; Jackie Johnston, Palliative Care and Stomal Therapy Clinical Nurse Consultant, St Vincent’s Private Hospital, NSW; Zeinah Keen, 13 11 20 Consultant, Cancer Council NSW; Dr Elizabeth Murphy, Head, Colorectal Surgical Unit, Lyell McEwin Hospital, SA. We also thank the health professionals, consumers and editorial teams who have worked on previous editions.
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