Abdominoperineal Resection (APR)

Sometimes, colorectal cancer develops in the very lowest part of the rectum, near the anus. If the tumour is in this area, the safest way to remove it completely is by performing surgery that includes the rectum and the anal canal. Doctors often call this an Abdominoperineal Resection (APR).

Abdominoperineal resection is an intensive surgical approach for low-lying rectal cancers. The procedure necessitates the complete removal of the affected rectum, the anus, and all local tissues containing the tumour. As the anal canal is removed, the patient loses the ability to pass stool normally, which leads to necessitating a permanent colostomy. Read on to learn in detail.

The rectum is the final section of your bowel where stool is stored before it leaves your body. When cancer grows very close to the anus, it is sometimes not possible to remove the tumour while keeping the muscles needed for bowel control intact.

During an APR, your surgeon will remove:

• The lower part of the colon
• Your entire rectum
• The anal canal
• Nearby tissues potentially containing cancer

Because the sphincter muscles are removed, you will need a permanent colostomy, allowing waste to exit through a small abdominal opening. While other techniques exist, APR is often the safest choice for low tumours.

Facing a diagnosis of rectal cancer is daunting, but your medical team is there to find the safest path forward. If a tumour is very low in the rectum, your consultant might suggest an abdominoperineal resection. This happens when the cancer is too close to the anal muscles to be removed safely while keeping them intact.

Tests like MRIs and biopsies act as a roadmap for your surgeon. This procedure is usually considered if: 

• The cancer is very near the anal opening.
• The sphincter muscles are involved.
• Other surgeries wouldn't remove the cancer fully. 

Afterwards, specialists examine the tissue to ensure the high-quality follow-up care for your recovery.

Not every person with bowel cancer needs a surgery called an abdominoperineal resection. Doctors only suggest it after carefully checking your scans and tests to see what is appropriate for you. 

You might be considered for this operation if: 

• The cancer is at the very bottom of your back passage.
• The tumour affects the muscles you use to go to the loo.
• The cancer can’t be removed while keeping your bowel control.
• You need the rectum and anus removed to get rid of the cancer. 

A team of experts, including surgeons and cancer specialists, will meet to decide if this is your suitable option.

Abdominoperineal resection is a primary treatment for low rectal cancer, but its use depends on patient fitness. A thorough pre-operative screening determines if a patient can withstand the rigours of the procedure. 

The surgery may be unsuitable for those with: 

• Major cardiac or respiratory failure.
• Unstable medical vital signs.
• Extensive metastatic disease.
• High anaesthetic risk. 

When surgery is deemed inappropriate, doctors provide alternative care pathways. This ensures that treatment remains effective without compromising the patient’s safety during the intervention process.

Abdominoperineal resection is a major surgical procedure performed by colorectal specialists and anaesthetists. General anaesthesia is mandatory for this operation. 

The attending medical team is responsible for explaining the procedure and post-operative colostomy function. The assessment covers: 

• Medical records and current prescriptions.
• History of radiotherapy or chemotherapy.
• All relevant imaging and biopsies. 

Patient compliance is required regarding: 

• Pre-operative fasting (nil by mouth).
• Identifying blood-thinning medications.
• Completing bowel preparation. 

Strict adherence to these protocols is necessary to minimize surgical complications and ensure the theatre team can operate under optimal conditions for the patient’s health.

During your abdominoperineal resection, your surgical team works through both the abdomen and the area between the genitals and the back passage (the perineum). First, an opening is made in the abdomen to carefully free the rectum from its surroundings. 

The surgeon removes the cancer, the rectum, and the anal canal. They also take nearby lymph nodes to check if the cancer has travelled. A second small opening is made at the perineal region to complete the removal. To help you recover, a permanent colostomy is created, allowing waste to pass into a bag. The operation is thorough and may take a few hours.

Following the procedure, patients are observed in a recovery area. A hospital stay of several days is standard for postoperative care. 

We’ll be right there to help with: 

• Making sure you aren't in pain.
• Supporting your wound healing.
• Helping you enjoy food and drink again.
• Building your confidence with the colostomy. 

Our stoma nurses are experts at helping you manage your bag with ease. Any tiredness or soreness you feel now is just temporary.

Abdominoperineal resection carries specific surgical risks. Medical precautions are implemented at every stage to reduce the likelihood of complications. 

Some things that could happen include: 

• Bleeding
• An infection in the wound
• Blood clots
• Slow healing at the bottom
• Issues with the colostomy bag 

Serious problems are rare, and we will be watching you closely to help with any concerns.

An abdominoperineal resection is an important step in treating certain types of rectal cancer found low down. Your team suggests this path to give you the best chance of becoming cancer-free. 

This procedure helps your doctors: 

• Remove the cancer entirely.
• Clear any cancer from the surrounding area.
• Check your lymph nodes to understand the disease.
• Plan the right follow-up care for you. 

When a tumour is very close to the anus, this surgery is a highly effective way to protect your future health.

Gleneagles Hospitals have expert bowel surgeons who perform abdominoperineal resection surgeries. The hospital offers full cancer care with the latest equipment and a team of experts working together. 

Available services: 

• Experienced bowel surgery teams
• Modern operating rooms
• Combined care from cancer and X-ray doctors
• Advanced scans and testing
• Specialist stoma bag support
• Careful monitoring after surgery

Patients receive clear advice before their operation and plenty of help as they recover.

Used for low-lying rectal cancer, an abdominoperineal resection removes the rectum and anus to achieve total clearance. This requires a permanent colostomy for waste management. It is a targeted decision made only when it offers the suitable clinical outcome. Specialists at Gleneagles Hospitals take a data-driven, careful approach to recommending this surgery as part of a comprehensive cancer plan.