Medical Oncologist
CION Cancer Clinics
Abdominoperineal resection: what is actually removed | CION Cancer Clinics
An abdominoperineal resection removes the whole rectum, the anus with its muscle ring, and the fatty sleeve of lymph glands around them. Because the anus is gone, the bowel cannot be rejoined, so the end of the colon becomes a permanent stoma on the belly. This page walks through each part that is removed, what stays, and what the operation cannot tell you on its own. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MM
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
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- What is removed in an abdominoperineal resection?
- What each removed part is, and why it goes
- What happens, in the order it happens
- Words you will see on the operation note and pathology report
- What goes, and what stays
- Who this operation is not for, and what this page cannot tell you
- Four things families say about this operation, and what is true
- Common questions about what an APR removes
The short answer
What is removed in an abdominoperineal resection?
An abdominoperineal resection, usually shortened to APR, removes the whole rectum, the anus and the ring of muscle that closes it, together with the fat and lymph glands around them. Because the anus is gone, the bowel cannot be joined back up, so the end of the colon is brought out through the belly wall as a permanent stoma.
Why so much has to come out
The rectum is the last part of the bowel, just above the anus. When a cancer grows in its lowest part, or into the anal muscle itself, there is no healthy bowel below it to join to. Leaving the anus would mean leaving cancer behind, so the rectum and anus come out as one piece with the tissue the cancer spreads into first.
Why it needs two approaches
The name describes the two routes. "Abdomino" is the part done through the belly, by one cut or several keyhole cuts. "Perineal" is the part done from below, through the skin between the anus and the tailbone. The two meet in the middle and the whole piece is lifted out from below.
Your surgeon may describe this as a "permanent colostomy operation". It is the same procedure.Part by part
What each removed part is, and why it goes
These are the structures named on most operation notes. Your own list may be shorter or longer, depending on where the cancer sits.
The rectum
The final stretch of the large bowel, where stool is stored before you pass it. The whole length is removed, from the end of the sigmoid colon down to the anus.
The anus and its muscle ring
The anal canal and the two rings of muscle around it, called the sphincters, are what let you hold stool in. Without them the bowel cannot be controlled from below, which is why the stoma is permanent.
The fat and glands around the rectum
The rectum sits inside a sleeve of fatty tissue called the mesorectum. This holds the lymph glands the cancer is most likely to spread to first, so the sleeve is removed whole and unopened.
On the pathology report as
- Mesorectum, or total mesorectal excision
- Number of lymph nodes examined
Sometimes, more
If the cancer has grown through the rectal wall, the surgeon may also take part of the pelvic floor muscle, a patch of skin around the anus, or a small part of a neighbouring organ such as the vagina or prostate. This is planned from your scans, not decided on the day.
Not sure whether this applies to you?
Ask an oncologistDuring the operation
What happens, in the order it happens
The part through the belly
Under a general anaesthetic, the surgeon frees the sigmoid colon and the rectum from the tissue around them, keeping the fatty sleeve intact. The blood supply to the rectum is tied off and the colon is divided above the cancer.
The part from below
A second cut is made around the anus. The surgeon works upwards through the pelvic floor until the two parts of the operation meet. The rectum, anus and surrounding tissue then come out as one piece through the lower wound.
Making the stoma
The cut end of the colon is brought out through a small opening in the left side of the belly wall, at the spot marked on your skin before surgery, and stitched to the skin. This is the colostomy.
Closing the wounds
The wound between the buttocks is closed with stitches, sometimes with a drain left in for a few days. The belly wounds are closed separately. You wake with a bag over the stoma and, usually, a urine catheter.
On your paperwork
Words you will see on the operation note and pathology report
- APR or APER
- Abdominoperineal resection, or abdominoperineal excision of rectum. Two names for the same operation.
- TME
- Total mesorectal excision. Removing the rectum together with its whole fatty sleeve, without cutting into that sleeve.
- Sphincter
- The ring of muscle that closes the anus. "Sphincter-preserving" means an operation that keeps it. An APR does not.
- CRM or circumferential margin
- The rim of healthy tissue around the outside of the removed piece. The pathologist measures how close the cancer came to that edge.
- End colostomy
- A stoma made from the cut end of the colon. The word "end" tells you it is the permanent kind, not a temporary loop.
- Levator
- The sheet of muscle that forms the pelvic floor. Some APRs remove part of it deliberately; that version is called an extralevator APR.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Side by side
What goes, and what stays
Removed
Left in place
The rectum and the anus, with the muscle ring
The rest of the large bowel, which keeps working normally
The fatty sleeve and the lymph glands inside it
The bladder, in almost every case
A small patch of skin around the anus
The nerves that control the bladder and sexual function, wherever the cancer allows
Part of the pelvic floor, in the extralevator version
The womb, prostate and vagina, unless the cancer has grown into them
Being straight with you
Who this operation is not for, and what this page cannot tell you
An APR is only offered when the cancer is too low for the anus to be saved. If the tumour sits higher in the rectum, an operation that joins the bowel back together is usually possible. This page cannot tell you which operation you need. That comes from your MRI, your examination and the tumour board discussion.
When it may not be the right step at all
If scans show the cancer has already spread to the liver or lungs, the team may recommend chemotherapy first and decide about surgery later. If your heart or lungs are not strong enough for a long anaesthetic, a shorter operation or radiotherapy may be discussed instead. None of this is a verdict.
What the removed tissue tells the team afterwards
Everything taken out goes to the pathologist. The report, usually back within a week or two, says how far the cancer had grown, whether the glands were involved and whether the edges were clear. That report decides whether you need further treatment. It does not tell you what the years ahead hold, and no honest surgeon will read that into it.
Bring the pathology report to your follow-up and ask the surgeon to go through it line by line.Commonly believed
Four things families say about this operation, and what is true
"They are removing the whole bowel."
They are removing the last part of it. The colon above the sigmoid stays and keeps doing what it always did. Digestion and the absorption of food are not affected. What changes is where the stool leaves the body.
"If the surgeon is skilled enough, the anus can always be saved."
Skill is not the limit. Position is. When the cancer involves the muscle ring itself, saving the ring means leaving cancer behind. A second opinion is always reasonable, but the answer often comes from the MRI rather than from who is operating.
"Once the tumour is out, no other treatment is needed."
That depends entirely on what the pathologist finds. Many people have radiotherapy or chemotherapy before the operation, and some need chemotherapy afterwards. The plan is not finished on the day of surgery.
"The stoma can be reversed later once things settle."
Not after an APR. Reversal needs an anus to join the bowel back to, and the anus has been removed. A stoma that can be reversed belongs to a different operation. Ask your surgeon which one is planned for you before you consent.
Questions we are asked
Common questions about what an APR removes
Is the whole anus really taken out? Will there be a hole?
Yes, the anus and the skin around it are removed. There is no hole afterwards. The surgeon closes the skin between the buttocks with stitches, so once healed there is a scar where the anus used to be and nothing opens there. Stool leaves the body only through the stoma.
Why can they not just remove the tumour and leave the rest?
Rectal cancer spreads first into the fatty sleeve and lymph glands around the rectum, which the eye cannot see. Taking only the visible lump would leave those behind. Removing the rectum with its whole sleeve in one piece gives the pathologist a clear edge to check.
Will I still have a normal bowel above the stoma?
Yes. The colon above the sigmoid is untouched and works as it did before. Food is digested and absorbed in the same way. Stool forms as normal and passes through the stoma into a bag instead of being stored in the rectum.
Are any organs near the rectum removed as well?
Usually not. The bladder, womb, prostate and vagina are left alone unless the MRI shows the cancer growing directly into one of them. If so, your surgeon will tell you before the operation, because it changes the consent form and the recovery.
Will the operation affect my bladder or my sex life?
It can, because the nerves for both run very close to the rectum. Surgeons work to keep them, but a cancer that has grown outwards sometimes leaves no safe route around them. Ask directly what the risk is in your case. Both problems have treatments afterwards, easier to arrange if raised early.
Is it done as keyhole surgery or an open cut?
The belly part can be done either way, and the part from below is always a cut around the anus. Which approach suits you depends on the size of the tumour, any previous surgery and your build. Ask your centre which they are planning and why.
Where will the stoma be?
On the left side of the belly, below the navel, at a spot the stoma nurse marks on your skin before the operation. The mark is chosen so you can see and reach it easily, and so the bag sits flat when you sit, bend and wear your usual clothes.
Can I get a second opinion before agreeing to this?
Yes, and no good surgeon will mind. Take your MRI, colonoscopy and biopsy reports with you. What you are asking is whether the anus can be saved in your case, and what the trade-off would be. Call the helpline if you would like help arranging that.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Sources
- Cancer Research UK — Surgery for rectal cancer
- Macmillan Cancer Support — Abdominoperineal resection (APR)
- National Cancer Institute — Rectal Cancer Treatment (PDQ) - Patient Version
- American Cancer Society — Surgery for Colorectal Cancer
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 reason the anus cannot be saved, in plain wordsAPR vs Low Anterior Resection: How the Choice Is MadeThe operation that keeps the anus, and when it is possibleStoma Siting Before APR: Why It Is MarkedHow the spot on your belly is chosenThe Pathology Report After SurgeryWhat the report on the removed tissue meansDeciding on Cancer SurgeryQuestions to ask before you consent
Talk to us
Been told you need this operation?
Send us your MRI and biopsy reports or call the helpline. A surgical oncologist will go through what is planned for you and what to ask. One helpline serves every CION centre.