Rectal Cancer Surgery

Rectal cancer begins in the rectum, the lower part of the large intestine (sigmoid colon) where stool is held until it passes out of the body through the anus. In many cases, the tumor develops from abnormal growths (polyps) in the rectal lining. If left untreated, benign polyps can grow and become cancerous over time. Although the exact cause of rectal cancer is not fully understood, certain factors can increase the risk, such as smoking, a low-fiber diet, a sedentary lifestyle and a family history of colorectal cancer. Symptoms include changes in bowel habits, blood in the stool, abdominal pain and unexplained weight loss.

Rectal cancer is staged with computed tomography (CT) scans of the chest, abdomen and pelvis and magnetic resonance imaging (MRI) scans of the rectum. Treatment can vary depending on the stage of the tumor. Many patients receive a combination of chemotherapy, radiation therapy and surgery.

To address locally advanced rectal cancer, chemotherapy and radiation therapy may be given upfront. This approach aims to shrink the tumor, increase the likelihood of sphincter preservation and reduce the risk of local recurrence. Once the first round of treatment is complete, the scanning process will be repeated to help the healthcare team assess the response to treatment. If no visible cancer is found, the physician may suggest a wait-and-watch approach; otherwise, the patient will typically proceed with surgery.

Because the rectum is situated deep within the pelvis, rectal cancer surgery is generally more complex than colon cancer surgery. For rectal cancer, the main surgical technique is total mesorectal excision (TME), which involves removing a portion of the rectum and some surrounding mesorectal fat, lymph nodes and blood vessels. Depending on the tumor’s stage, size and location and the patient’s overall health and preferences, the surgeon may perform an anterior resection, low anterior resection or abdominoperineal resection. Additionally, some patients require a temporary or permanent ostomy, a surgically created opening in the abdomen that allows waste to exit the body when its natural passage through the rectum or colon is not possible. The waste is collected in a pouch or bag attached to the outside of the body.

Anterior resection or low anterior resection (LAR) surgery for rectal cancer

Anterior resection surgery may be considered to address a tumor located in the upper part of the rectum near the sigmoid colon. This procedure involves removing the cancerous sections of the upper rectum and adjacent sigmoid colon while preserving the anal sphincter, allowing normal bowel function to continue after surgery.

A specific variation of anterior resection, LAR surgery may be considered to address a tumor located in the middle or lower part of the rectum. This procedure involves removing a longer portion of the rectum and sigmoid colon and reconnecting the remaining rectum to the anus. Due to the proximity of the anal sphincter, LAR surgery requires precise reconstruction techniques.

How to prepare for anterior resection or low anterior rection surgery for rectal cancer

Preparing for anterior resection or LAR surgery involves several important steps. The patient will need to undergo preoperative testing, such as blood work, imaging studies and a colonoscopy, to help the surgeon assess their overall health and the extent of the rectal cancer. The surgical team may recommend dietary adjustments, such as transitioning to a clear liquid diet, and bowel preparation to empty the intestines before surgery. The patient should inform their surgeon about any medications they are taking because some, such as blood thinners, may need to be temporarily adjusted. The patient will also receive personalized guidance on quitting smoking if appropriate, increasing physical activity and preparing for their recovery at home. The presurgical consultation will include discussions about the procedure, anesthesia and the possible need for a temporary or permanent ostomy.

What to expect after anterior resection or low anterior rection surgery for rectal cancer

After anterior resection or LAR surgery, the patient can expect a few days of hospital monitoring, pain management and a gradual return to normal activities. Initially, the patient may experience discomfort, fatigue and limited mobility. As the body adjusts to changes in the rectum, bowel function may be irregular, including diarrhea or urgency. If an ostomy was created, the patient will receive guidance on how to manage it. Full recovery can take up to several months depending on the individual and the extent of the procedure. Follow-up appointments will be scheduled to monitor healing and evaluate the effectiveness of the surgery.

Services and features at Moffitt McKinley Hospital include:

• Surgery operating and recovery rooms
• Radiology/diagnostic imaging
• Pathology and laboratory
• Publix Pharmacy
• Ancillary clinical services
• Patient and Family Center
• Café and cafeteria
• Gift shop

What are the risks and potential complications of anterior resection or low anterior rection surgery for rectal cancer?

Anterior resection and LAR surgery carry several risks and potential complications. Anastomotic leakage can lead to peritonitis, a life-threatening infection. Postoperative bleeding and infection at the surgical site or within the abdominal cavity are also possible. Additionally, some patients experience low anterior resection syndrome (LARS), which is characterized by fecal incontinence, urgency, frequent bowel movements and a feeling of incomplete evacuation.

Though rare, damage to autonomic nerves during surgery can result in urinary retention, erectile dysfunction, retrograde ejaculation, dyspareunia, infertility and other sexual health issues. Scar tissue formation can lead to adhesions, causing bowel obstruction, pain and swelling. Some patients also experience long-term changes in bowel function, including altered stool consistency and frequency, which can persist for months or longer. A thorough understanding of these potential risks and complications is essential for informed decision-making and appropriate postoperative care.

Abdominoperineal resection (APR) surgery for rectal cancer

APR surgery may be considered to address a tumor located very low in the rectum, where it may be too close to the anal sphincter to allow for reconnection of the bowel (anastomosis). During the procedure, the surgeon will remove the anus, rectum and part of the sigmoid colon through abdominal and pelvic (perineal) incisions. Afterward, the surgeon will create a permanent colostomy to allow waste to exit the body.

How to prepare for abdominoperineal resection surgery for rectal cancer

Preparing for APR surgery involves several key steps. The surgeon will provide specific instructions, which may include dietary restrictions and bowel preparation to ensure the colon is empty before surgery. The patient may be instructed to follow a clear liquid diet for one to two days before the procedure and to take prescribed laxatives or an enema. The patient will also need to stop taking certain medications, such as blood thinners, as directed by the surgeon. A preoperative assessment, including blood tests and imaging studies, may be required to evaluate the patient’s overall health. The patient should make appropriate arrangements for post-surgical care, including the management of a permanent colostomy.

What to expect after abdominoperineal resection surgery for rectal cancer

After APR surgery, the patient can expect several weeks of recovery. Immediately following the procedure, the patient will be closely monitored in the hospital for several days to ensure proper healing and manage any pain. In addition to a drainage tube at the surgical site, the patient will have a temporary catheter in place for urinary drainage.

The patient may have limited mobility for a short time and will be encouraged to gradually increase their activity level. The healthcare team will provide specific instructions on how to care for the colostomy.

In the weeks following APR surgery, the patient can expect some fatigue, discomfort and difficulty with bowel function. After starting with a modified diet, the patient will gradually transition back to regular foods. Full recovery can take time, and follow-up appointments will be necessary to monitor healing and check for complications.

What are the risks and potential complications of abdominoperineal resection surgery for rectal cancer?

The APR procedure is complex and carries several risks, including infection, bleeding, anastomotic leaks and damage to nearby organs, such as the bladder and urethra. Possible complications include blood clots, issues related to the colostomy, such as skin irritation and hernia formation, delayed healing of the perineal wound and urinary, bowel or sexual dysfunction due to nerve damage. Before the procedure, the surgeon will fully discuss the risks and provide individualized guidance to help minimize complications and support recovery.

Benefit from world-class care at Moffitt Cancer Center

Gastrointestinal cancers are common and among the most challenging tumors to treat. Multispecialty care is key to achieving the best possible outcome and quality of life. Moffitt’s renowned Gastrointestinal Oncology Program focuses exclusively on colon and rectal cancers, allowing our patients to receive care from some of the foremost experts in the field, including surgeons, medical oncologists, radiation oncologists, endoscopists, pathologists and radiologists. We also have a specialized senior adult clinic to help coordinate and optimize care for patients 75 and older.

Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center, recognized internationally for our commitment to innovation in research and treatment as well as our robust portfolio of clinical trials. In our Gastrointestinal Oncology Program, our patients can benefit from the latest advances in endoscopic, laparoscopic and minimally invasive rectal cancer surgery. We also offer novel chemotherapy drugs, minimally invasive treatments performed by interventional radiologists, molecular therapies, immunotherapies, pain management and supportive care. Due to our tireless commitment to bettering diagnostic and treatment options for gastrointestinal cancers, our patient survival rates consistently exceed the national averages, even for late-stage tumors.

If you would like to learn more about rectal cancer surgery, you can request an appointment with a specialist in the Gastrointestinal Oncology Program at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.

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