Abdominoperineal resection (APR) is major surgery for low rectal cancer close to the anal sphincter, when the anus cannot be preserved safely. The rectum, anus and sphincter are removed with surrounding tissue, aiming for complete removal of the tumour with clear margins. The treating team decides whether it is suitable.
The operation is done under general anaesthesia, by keyhole, robot-assisted or open surgery. The surgeon removes the lower colon together with the rectum and anus, closes the skin where the anus was, and creates a permanent colostomy in the abdominal wall, from which stool passes into a special bag. Passing stool through the natural anus is therefore no longer possible.
Surgery often takes four to six hours, and the hospital stay may last a week to ten days. The patient learns stoma care with a specialist nurse. Recovery from the operation takes several weeks, while adjusting to the stoma and healing of the perineal wound usually take a few months, with follow-up continuing under the cancer team.
The final cost is set after a medical consultant reviews your case and photos.
Our medical consultants review all requests regularly, every three hours.
Get a free consultation and answers to all your questions by completing the form below
It aims to remove a low rectal tumour with clear margins and to control the disease locally when the sphincter cannot be preserved safely. A cure cannot be guaranteed, as results depend on the stage of the disease and its response to treatment, which the treating team will explain.
It is suited to patients whose tumour lies in the lower rectum or extends into the sphincter or surrounding muscles, and for whom the anus cannot be preserved safely. The cancer and surgical team decides after endoscopy, MRI and other imaging.
Preparation includes blood tests, imaging and an assessment of the heart and lungs, and chemotherapy or radiotherapy may be given beforehand if the team decides so. The stoma site is usually marked in advance with a specialist nurse, and medicines, including blood thinners, are only adjusted on the doctor's advice.
After general anaesthesia, the surgeon reaches the abdomen through an incision or by keyhole, separates the lower colon, and removes the rectum, anus and sphincter together with nearby lymph nodes. A permanent colostomy is then created in the abdominal wall and the perineal wound is carefully closed.
Painkillers ease discomfort during the hospital stay, and the perineal wound may heal slowly and need special care. Movement returns gradually over several weeks, and heavy lifting is avoided for a period set by the surgeon.
The pathology report shows the surgical result on the tumour, and adjustment to the stoma develops gradually over some months. The colostomy is permanent, and regular follow-up with scans and tests usually continues for years according to the team's plan.
They include bleeding, infection, slow healing of the perineal wound, bowel obstruction and stoma problems such as skin irritation or hernia. Urinary and sexual function may be affected because nerves lie close to the operation site. This is major surgery, and the surgeon explains the risks for your situation.
Yes. There is a scar on the abdomen, or several small scars after keyhole surgery, a scar in the perineal area, and the permanent stoma on the abdominal wall.
Staying about two to four weeks after the operation is usually advised. The treating doctor confirms the travel date after checking the wound and your confidence with stoma care, and travel should not happen before the condition is stable.
You learn stoma care with a specialist nurse before and after leaving hospital, and modern bags allow many patients a normal daily routine. Psychological support and patient groups can help, and the team advises on diet, activity and returning to work.
