Medical Oncologist
CION Cancer Clinics
Rectal cancer surgery: what your options are | CION Cancer Clinics
Most rectal cancers are treated with one of two operations. A low anterior resection removes the cancer and joins the bowel back together. An abdominoperineal resection removes the rectum and anus and leaves a permanent stoma. Where the cancer sits decides which one is offered. This page explains each option, how the team chooses, and what the page cannot tell you. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What are the surgical options for rectal cancer?
- What each operation actually involves
- How does the team decide which operation to offer?
- LAR and APR compared
- Words you will see, in plain language
- Four things families tell us, and what is actually true
- What this page cannot tell you
- Common questions about rectal cancer surgery
The short answer
What are the surgical options for rectal cancer?
For most rectal cancers there are two main operations. A low anterior resection (LAR) removes the part of the rectum with the cancer and joins the bowel back together, so you keep passing stool the normal way. An abdominoperineal resection (APR) removes the rectum and the anus and leaves a permanent stoma, an opening on the tummy where stool collects in a bag.
Two other paths for some people
A small, early cancer can sometimes be removed through the anus without opening the tummy. This is transanal or local excision. A few people whose cancer disappears completely after radiation and chemotherapy may be offered close watching instead of an operation. Neither path is open to everyone.
What decides between them
Mostly, where the cancer sits. The rectum is the last part of the large bowel, just above the anus. The lower the cancer, the closer it is to the sphincter, the ring of muscle that holds stool in. If a rim of healthy bowel can be left below the cancer, a join is usually possible. If the cancer has grown into that muscle, the anus has to go with it.
This page describes the operations. It cannot tell you which one is right for you. That comes from your MRI, your examination and your surgeon.The operations
What each operation actually involves
Each leads to a different life afterwards. The names are on your report, so here is what they mean.
Low anterior resection (LAR)
The rectum with the cancer is removed along with the fatty tissue around it, and the colon above is joined to the rectum or anus below. Many people have a temporary ileostomy, a small bag on the right side, to protect the join while it heals.
Usually offered when
- The cancer is in the upper or middle rectum
- The sphincter muscle is not involved
Abdominoperineal resection (APR)
The rectum and anus are removed together, the bottom is closed with stitches, and the end of the colon is brought out on the left of the tummy as a permanent colostomy.
Usually offered when
- The cancer involves the anal muscle
- A join would leave no working control
Transanal (local) excision
The surgeon removes just the cancer and a rim of bowel wall through the anus. No tummy cut, no stoma. It suits only small, early cancers that have not gone deep into the wall.
If the tissue shows the cancer went deeper than expected, a bigger operation may still be advised.Watch and wait
When no cancer can be found after radiation and chemotherapy, some centres offer very close follow-up instead of surgery. Surgery is kept ready if anything returns.
Not sure whether this applies to you?
Ask an oncologistHow the choice is made
How does the team decide which operation to offer?
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The MRI of the pelvis
The scan that matters most. It shows how far the cancer has grown through the bowel wall, how close it is to the sphincter, and whether the lymph glands nearby look involved.
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The examination
Your surgeon examines the back passage with a gloved finger and often a short telescope. This shows how low the cancer sits and how well the muscle squeezes, which no scan can show.
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Radiation or chemotherapy first
Many rectal cancers are treated with radiation, often with chemotherapy, before surgery. This can change which operation is possible, so the operation is planned after a repeat MRI.
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The tumour board
Surgeons, oncologists and radiologists discuss your scans together and agree a recommendation.
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The conversation with you
You are told which operation is recommended, what the alternative was, and what life afterwards looks like for each.
Side by side
LAR and APR compared
Low anterior resection
Abdominoperineal resection
Bowel is joined; you pass stool through the anus
Anus is removed; stool collects in a bag for life
Often a temporary ileostomy, closed in a second smaller operation
One stoma, made once, no reversal later
Bowel habit changes after the join: urgency, frequency, clustering
No urgency, but a bag to learn and a slow-healing wound at the bottom
Chosen when the cancer sits high enough for a safe join
Chosen when the cancer involves the sphincter
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On your report
Words you will see, in plain language
- Proctectomy
- The general word for removing the rectum. LAR and APR are both types of proctectomy.
- Total mesorectal excision (TME)
- Removing the rectum with the fatty envelope around it, in one piece. This is how the lymph glands come out, and it is the standard for most rectal operations.
- Anastomosis
- The join between the two ends of bowel. A "coloanal" anastomosis is a join made at the anus itself.
- Stoma
- An opening on the tummy for stool to leave the body into a bag. An ileostomy is made from small bowel and is usually temporary. A colostomy after APR is permanent.
- Neoadjuvant
- Treatment given before the operation, usually radiation with or without chemotherapy, to shrink the cancer first.
Commonly believed
Four things families tell us, and what is actually true
"Rectal cancer surgery always means a bag for life."
It does not. Most people whose cancer sits in the upper or middle rectum have a join and keep passing stool normally. A temporary ileostomy is common, but it is closed later. A permanent bag is mainly for cancers that involve the anal muscle.
"Keyhole means the surgeon takes less out."
Keyhole and open surgery remove the same tissue. The difference is the size of the cuts on the tummy, not what is done inside. Ask your centre which approach it uses for your operation and why.
"If the scan is clear after radiation, surgery is not needed."
A clear scan is good news, but scans can miss small amounts of cancer. Watch and wait is offered only in selected cases with very close follow-up. For most people, surgery after radiation is still the recommended path.
"The lower operation is the more dangerous one."
Both are major operations with similar risks in the first weeks. The real difference is life afterwards: changed bowel habit after a low join, or living with a colostomy after APR. The safer operation for you depends on your own case.
Being straight with you
What this page cannot tell you
It cannot tell you which operation you will have. That depends on the exact height of the cancer, how it responds to treatment given first, how well your sphincter works today, and your general fitness. Two people with the same stage can be offered different operations for good reasons.
Who a low join may not suit
A join very low in the pelvis is harder to advise for someone whose bowel control was already poor, or whose heart or lungs make a long operation and a second reversal operation risky. In those cases a permanent colostomy is sometimes the kinder choice. That is a decision to make with your surgeon, not from a web page.
Questions worth asking
Ask how far the cancer is from the anus on the MRI. Ask whether radiation is planned first, and whether the operation will be decided after a repeat scan. Ask whether a temporary stoma is likely. Ask what your bowel habit is expected to be like a year on. Write the answers down.
If you have an MRI report and are not sure what it means, call the helpline. A surgical oncologist will go through it with you.Questions we are asked
Common questions about rectal cancer surgery
Will I definitely need a stoma bag?
Not definitely. If the cancer sits high enough for a join, many people have a temporary ileostomy for some months and then have it closed. A permanent colostomy is needed when the anus has to be removed. Your surgeon can usually say which is likely once the MRI has been reviewed.
Can the operation be done by keyhole?
Often, yes. Keyhole and robotic approaches use small cuts and a camera; open surgery uses one longer cut. What is removed inside is the same. Whether keyhole suits you depends on the cancer, previous tummy operations and your build. Ask your centre which approach it uses and why.
Why do I need radiation before surgery?
Radiation, often with chemotherapy, shrinks the cancer and lowers the chance of it coming back in the pelvis. For cancers that sit low or have grown through the bowel wall it is usually given first. It also gives the team a second look at the MRI before the operation is chosen.
How long will I be in hospital?
It varies with the operation, your fitness and whether a stoma has to be learned before you go home. Keyhole surgery usually means a shorter stay than open. Your surgeon will give an expected stay for your own case, and it is normal for that to change if recovery is slower.
Will my bowels ever work normally again?
After a join, bowel habit changes for most people: urgency, going more often, and passing small amounts several times in a row. This usually settles over months and there is a lot that can be done to help. Nobody can promise a return to exactly how things were.
Can I choose the stoma instead of the join?
You can ask for that conversation. Some people with poor bowel control, other illnesses, or who do not want the uncertainty of a low join prefer a permanent colostomy. It is a reasonable choice in the right situation, and your surgeon should talk it through honestly.
Does surgery affect sex or passing urine?
It can. The nerves that control the bladder and sexual function run close to the rectum. Surgeons work to protect them, but some people notice changes, particularly after radiation and a very low operation. Ask about this before surgery, when it is easier to plan for.
Is rectal surgery covered by Aarogyasri or my insurance?
Often yes, when it is part of an approved cancer treatment plan. Aarogyasri, CGHS, ECHS and EHS are accepted, and most cashless insurers are empanelled. What your own cover pays depends on the scheme and the operation. Call the helpline with your card details and we will check.
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Dr. C. Raghavendra Reddy
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Dr. Owais Mohammed
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Dr. Vajja Sandeep Kumar
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Sources
- Cancer Research UK — Surgery for bowel cancer
- National Cancer Institute — Rectal Cancer Treatment (PDQ) - Patient Version
- American Cancer Society — Surgery for Rectal Cancer
- NHS — Bowel cancer: Treatment
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
Low Anterior Resection ExplainedThe join operation, step by stepHow Close to the Anus Can the Sphincter Be Saved?What decides between a join and a permanent stomaSphincter-Saving Surgery vs Permanent StomaLife afterwards, compared honestlyDeciding on Cancer SurgeryWhat the team weighs and what to askProctectomy Cost in HyderabadIndicative ranges and what schemes cover
Talk to us
Been told you need rectal surgery and want to understand the options?
Send us your MRI and biopsy reports or call the helpline. A surgical oncologist will explain what they mean for the operation you are likely to be offered. One helpline serves every CION centre.