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. There are two common types of operation – 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 (loss of control over bowel movements). After an abdominoperineal resection, you will need a permanent stoma (colostomy). For more on this, see Having a stoma and speak to your surgeon about any concerns you may have.
Types of resections
High anterior resection
The surgeon removes the 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 resection
The 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 colonic J-pouch below).
An 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 David A Clark, Colorectal Surgeon, Royal Brisbane and Women’s Hospital, and The University of Queensland, QLD, and The University of Sydney, NSW; A/Prof Siddhartha Baxi, Radiation Oncologist and Medical Director, GenesisCare Gold Coast, QLD; Dr Hooi Ee, Specialist Gastroenterologist and Head, Department of Gastroenterology, Sir Charles Gairdner Hospital, WA; Annie Harvey, Consumer; A/Prof Louise Nott, Medical Oncologist, Icon Cancer Centre, Hobart, TAS; Caley Schnaid, Accredited Practising Dietitian, GenesisCare, St Leonards and Frenchs Forest, NSW; Chris Sibthorpe, 13 11 20 Consultant, Cancer Council Queensland; Dr Alina Stoita, Gastroenterologist and Hepatologist, St Vincent’s Hospital Sydney, NSW; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, Canberra Hospital, ACT; Richard Vallance, Consumer.
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