Medical Oncologist
CION Cancer Clinics
APR or low anterior resection: how the choice is made | CION Cancer Clinics
A low anterior resection (LAR) removes the rectum and joins the bowel back to the anus. An abdominoperineal resection (APR) removes the anus too and leaves a permanent stoma. Which one you are offered depends on how far the cancer sits from the anus and whether its muscle ring can be kept with a clear edge. This page explains what the team weighs and what life is like after each. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- APR or LAR: which operation will I have?
- The two operations, compared
- What actually tips the choice one way or the other
- How the decision is reached, in order
- Words you will meet on the plan, in plain language
- Which one is easier to live with?
- Four things families say about the choice, and what is true
- Common questions about APR and LAR
The short answer
APR or LAR: which operation will I have?
It depends on how far the cancer sits from the anus, and on whether the ring of muscle that closes the anus can be kept without leaving cancer behind. A low anterior resection (LAR) removes the rectum and joins the bowel back to the anus. An abdominoperineal resection (APR) removes the anus as well, and leaves a permanent stoma.
The same aim, a different ending
Both operations remove the rectum with its sleeve of fat and lymph glands, through the belly, by open cut or keyhole. The difference is the bottom end. In a LAR the surgeon stops above the muscle ring, so there is a stump to join the colon to. In an APR the surgeon carries on through the ring and out through the skin, so there is nothing to join to.
Why you cannot simply choose
The choice is set mostly by the tumour. If the cancer involves the muscle ring or sits hard against it, a LAR would leave cancer behind, and no surgeon will offer it. If the cancer sits higher, a LAR is usually possible, and the question becomes whether the join would give you control you can live with.
This page cannot tell you which operation you need. That comes from your MRI and your surgeon's examination.Side by side
The two operations, compared
Low anterior resection (LAR)
Abdominoperineal resection (APR)
Rectum removed, anus and muscle ring kept
Rectum, anus and muscle ring all removed
Bowel joined back together low in the pelvis
No join; the colon ends at a stoma on the belly
Often a temporary stoma to protect the join, closed months later
A permanent stoma from the start
Bowel habit afterwards can be urgent, frequent or leaky
Bowel habit is managed through the bag, with no urgency
What the team weighs
What actually tips the choice one way or the other
Height of the tumour
How far the lower edge of the cancer sits from the anus, measured on the MRI and by the surgeon's finger. The lower it sits, the less room there is to cut below it and still keep the ring.
Whether the muscle ring is involved
If the MRI shows the tumour growing into the sphincter, or the sheet of muscle beside it, a LAR is off the table. A clear edge around the cancer comes before saving the anus.
How the tumour responded to radiotherapy
Many low rectal cancers have radiotherapy first. If the tumour pulls back from the ring, a LAR may become possible where it was not at the start. The team re-scans to check before deciding.
How well your muscle works now
A join only helps if the ring below it can hold stool. Someone who already leaks, or whose muscle has been weakened by childbirth or earlier surgery, may be offered an APR even where a LAR is possible. Tell your surgeon if you already leak stool or wind.
What you want, once you know the trade-off
Where both are possible, your view matters. Some people would rather accept a stoma than years of urgent trips to the toilet. Others want the join at any cost. Say which you are, and ask how your build and any earlier pelvic surgery affect the join.
Not sure whether this applies to you?
Ask an oncologistThe pathway
How the decision is reached, in order
MRI of the pelvis and examination
The MRI shows where the tumour sits and what it touches. The surgeon then examines you with a finger and a short telescope to confirm where the lower edge is and how strong the ring feels.
Radiotherapy first, if advised
For many low tumours the team gives radiotherapy, sometimes with chemotherapy, before any operation. This can shrink the cancer and pull it away from the muscle ring.
A second look
Some weeks after radiotherapy ends, you are scanned and examined again. A tumour that needed an APR at the start is sometimes found to allow a LAR instead. Sometimes it is not.
Tumour board and the conversation with you
Surgeons, oncologists and radiologists agree a recommendation. You are told which operation, why, and what the other would have meant. Ask every question you have.
On your paperwork
Words you will meet on the plan, in plain language
- Anterior resection
- Removing the rectum through the belly and joining the bowel back together. "Low" or "ultra-low" tells you how close to the anus the join sits.
- Anastomosis
- The join between the two cut ends of bowel. A "coloanal anastomosis" is a join made right at the anus.
- Intersphincteric resection
- A very low LAR where part of the inner muscle ring is removed to gain a clear edge, keeping the outer ring. Only suitable for some tumours.
- Defunctioning ileostomy
- A temporary stoma made from the small bowel to rest a new join while it heals. It is closed in a later operation.
- LARS
- Low anterior resection syndrome. The urgency, frequency and leaking that can follow a low join. It often improves with time, but not always.
Being straight with you
Which one is easier to live with?
Neither is easy, and it depends on the person. A stoma is visible and permanent, and most people dread it before surgery. A low join keeps the body looking as it did, but can leave the bowel unpredictable for a long time.
Who a LAR does not suit
A very low join does not suit someone whose muscle ring is already weak, someone who cannot reach a toilet quickly at work or on the road, or someone too frail for a second operation to close a temporary stoma. For those people a stoma they control is often the kinder result.
Who an APR does not suit
An APR is not offered where the anus can safely be kept and the muscle works well, because it removes something that did not need to go. It also leaves a wound between the buttocks that can be slow to heal, which matters more for someone who is very thin, has diabetes or has had heavy radiotherapy.
What this page cannot tell you
It cannot tell you what your bowel will be like after either operation, or what your outlook is. The type of operation carries no verdict on either. Ask your surgeon both questions directly.
Commonly believed
Four things families say about the choice, and what is true
"Keeping the anus is always the better outcome."
Not for everyone. A join that leaks or sends you to the toilet many times a day can be harder to live with than a stoma you manage on your own terms. The right result removes the cancer fully and gives you a life you can run.
"An APR means the surgeon has given up on the anus too easily."
When the tumour sits in or against the muscle ring, an APR is the operation that removes the cancer. A LAR there would leave disease behind. Ask to see the MRI, and ask for a second opinion if you want one.
"After a LAR, everything goes back to normal."
Usually not straight away, and sometimes not fully. Urgency, frequency and leaking are common after a low join and can take a year or more to settle. Knowing that in advance is part of choosing well, and there are treatments that help.
"The temporary stoma after a LAR is always reversed."
Most are, but not all. If the join heals poorly, if chemotherapy afterwards runs long, or if bowel function is very poor once tested, some people keep the stoma for longer or for good.
Questions we are asked
Common questions about APR and LAR
Can I ask for a LAR even if the surgeon recommends an APR?
You can ask, and you can ask for a second opinion. But if the tumour involves the muscle ring, a LAR would leave cancer behind, and no surgeon should agree to it. If the ring is clear and the question is only about bowel function afterwards, your view carries real weight.
Is one operation bigger or more dangerous than the other?
They are of similar size and both need a general anaesthetic of several hours. Each carries its own risks: a LAR can leak at the join, an APR has a wound between the buttocks that can be slow to heal. Ask which risks matter most in your case.
Does a LAR always need a temporary stoma?
Very often, when the join is low or you have had radiotherapy. The temporary stoma rests the join while it heals and protects you if it leaks. It is closed in a smaller operation later, once the join has been checked. Some higher joins can be made without one.
What is bowel function like after a low join?
Often unsettled at first. Many people pass stool in small amounts many times a day, feel sudden urgency, or leak a little. This tends to improve with time, diet and pelvic floor exercises. Some people are left with lasting problems, which is why the choice is discussed so carefully.
Can the decision change during the operation?
Rarely, but yes. If the surgeon finds the tumour closer to the ring than the scans suggested, or the tissue too scarred for a safe join, an APR may be done instead of a planned LAR. This is discussed beforehand and written on the consent form.
Does radiotherapy before surgery change which operation I get?
It can. Radiotherapy shrinks some tumours enough to pull them clear of the muscle ring, and the team re-scans some weeks later to check. If that happens, a LAR may become possible. It does not happen for every tumour.
Will either operation affect my bladder or sex life?
Both can, because the nerves for the bladder and for sexual function run close to the rectum. The risk depends more on where the tumour sits than on which operation is done. Ask about your own case, and raise any problem early, because there are treatments.
Are both operations covered by Aarogyasri and insurance?
Both are usually covered under Aarogyasri, CGHS, ECHS, EHS and most cashless insurers as part of an approved cancer treatment plan. The later operation to close a temporary stoma is usually covered too. Call the helpline with your card details and we will confirm.
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Dr. C. Raghavendra Reddy
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- Cancer Research UK — Surgery for rectal cancer
- Macmillan Cancer Support — Anterior resection
- American Cancer Society — Surgery for Rectal Cancer
- National Cancer Institute — Rectal Cancer Treatment (PDQ) - Patient Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Why Some Rectal Cancers Need a Permanent StomaThe reasons the anus sometimes cannot be savedAbdominoperineal Resection: What Is RemovedEach part an APR takes, and whyExtralevator APR ExplainedThe wider version of an APR and when it is usedDeciding on Cancer SurgeryQuestions to ask before you consentChoosing a Surgeon and a CentreHow to get a second opinion without offending anyone
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