Abdominoperineal resection (APR) removes the rectum together with the anus and sphincter, with total mesorectal excision (TME), and creates a permanent colostomy. It is chosen for very low rectal tumours where a sphincter-preserving resection is not oncologically safe.
What is the operation?
It is the complete removal of the rectum, anus and sphincter complex for cancer, following total mesorectal excision (TME) principles. Because the sphincter is removed, bowel continuity is brought out as a permanent colostomy.
It is chosen when sphincter preservation is not oncologically safe.
When is it needed?
It is indicated for a very low rectal cancer invading the sphincter or lying so low that preservation would not secure clear margins. The decision is made at a multidisciplinary team, often after neoadjuvant chemoradiotherapy.
Preparation
A pelvic MRI, endoscopy and CT are required for staging, along with stoma site marking with a specialist nurse and psychological preparation for the permanent colostomy.
How it's done
It combines an abdominal phase (mobilising the rectum along TME planes, chiefly laparoscopically/robotically) and a perineal phase (removing the anus with clear margins). A permanent colostomy is created and the perineal wound is carefully closed.
Laparoscopic/Robotic
Abdominal phase through small incisions with excellent pelvic access (TME).
Anus removal
Controlled removal of the anus and sphincter with oncological margins.
Permanent colostomy
Creation and marking of the stoma, with education and management support.
Recovery
Hospital stay lasts several days, with particular care of the perineal wound and colostomy management education. Adaptation is supported by a specialist stoma nurse.
Risks & outcomes
Possible: delayed perineal wound healing, urinary/sexual dysfunction (from the pelvic nerves), stoma complications. A quality marker is a complete (R0) resection with an intact mesorectum.
Frequently asked questions
Why is a permanent colostomy needed?
When the tumour is very low or invades the sphincter, removing it together with the anus is the only way to secure oncological margins — so bowel continuity is brought out as a permanent colostomy.
Can I live normally with a colostomy?
Yes. With proper education and support from a specialist stoma nurse, most patients return fully to their activities.
Will I need chemoradiotherapy?
In many low rectal cancers, neoadjuvant therapy comes first. The decision is made at the multidisciplinary team.
Is it done laparoscopically?
Yes, the abdominal phase is done chiefly laparoscopically/robotically, with excellent pelvic access.