Surgery for cancer in the rectum
The type of operation you have depends on where in the rectum the cancer is, whether the bowel can be rejoined, and where in the rectum the join can be made. There are 2 main types of operation – an anterior resection or an abdominoperineal resection (also known as an abdominoperineal excision).
This is the most common operation. You may have a high anterior resection or an ultra-low anterior resection (see below). As part of the procedure, the surgeon may create a temporary stoma, which will usually be reversed later. See more information about stomas.
This procedure may be recommended if the cancer is near the anal sphincter muscles or 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). See more information on having a stoma and speak to your surgeon about any concerns you may have.
Types of resections
There are different types of operations for cancer in the rectum. The surgery may be done as open or keyhole surgery.
High anterior resection
The 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 remaining rectum.
Ultra-low anterior resectionThe lower left part of the colon and all or part of the rectum are removed, along with nearby lymph nodes and surrounding fatty tissue. The end of the remaining bowel is joined to the lowest part of the rectum, just above the anus. In some cases, the surgeon may make a pouch using the remaining colon and join this pouch to the anus to improve ongoing bowel function. This is known as a colonic J-pouch.
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.
Podcast: Coping with a Cancer Diagnosis
A/Prof David A Clark, Senior Colorectal Surgeon, Royal Brisbane and Women’s Hospital, QLD, The University of Queensland and The University of Sydney; Yvette Adams, Consumer; Dr Cameron Bell, Gastroenterologist, Royal North Shore Hospital, NSW; Katie Benton, Advanced Dietitian Cancer Care, Sunshine Coast University Hospital and Queensland Health, QLD; John Clements, Consumer; Dr Fiona Day, Medical Oncologist, Calvary Mater Newcastle, NSW; Alana Fitzgibbon, Clinical Nurse Consultant, GastroIntestinal Cancers, Cancer Services, Royal Hobart Hospital, TAS; Prof Alexander Heriot, Consultant Colorectal Surgeon, Director Cancer Surgery, Peter MacCallum Cancer Centre, and Director, Lower GI Tumour Stream, Victorian Comprehensive Cancer Centre, VIC; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Dr Kirsten van Gysen, Radiation Oncologist, Nepean Cancer Care Centre, NSW.
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