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. Bowel continuity is brought out as a permanent colostomy.
When is it needed?
It is indicated for a very low rectal cancer that invades the sphincter or lies so low that preservation would not secure oncological margins. The decision follows precise staging.
Preparation
It requires pelvic MRI, endoscopy and CT, a decision at a multidisciplinary team (often with neoadjuvant chemoradiotherapy) and stoma site marking with a specialist nurse.
How it's done
It combines an abdominal phase (mobilising the rectum along TME planes, laparoscopically/robotically) and a perineal phase (removing the anus). A permanent colostomy is created on the abdominal wall.
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 care of the perineal wound and education in colostomy management. Adaptation is supported by a specialist stoma nurse.
Risks & outcomes
A demanding operation with very good oncological outcomes in specialist hands. Possible complications: delayed perineal wound healing, urinary/sexual dysfunction, stoma complications.
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.