Surgery for rectal cancer

Surgery is the most common type of treatment for rectal cancer and should be carried out by a surgeon who specialises in bowel surgery.

There are different types of rectal cancer surgery. Your doctor will discuss with you the most appropriate type of surgery, depending on the stage of your cancer and where it is in the rectum. You may be given radiotherapy or chemoradiotherapy before surgery to shrink the cancer and make it easier to remove.

Before your operation Back to top

Before your surgery the doctor and specialist nurses will explain the operation to you. They will tell you what to expect immediately after the surgery and in the few days following. This is a good opportunity to ask any questions about the operation.

You will probably be admitted to the ward the day before your operation, so that the doctors and nurses can do any further tests. To make sure that your bowel is completely empty, you’ll be asked to follow a strict diet and take a medicine (laxative) to help empty your bowels the day before surgery. Your nurse or the doctor will explain this to you. You will be given antibiotics as an injection into a vein (intravenously) just before and after surgery to prevent infections.

Types of rectal cancer surgery Back to top

Local resection, transanal resection or transanal endoscopic microsurgery

Very early-stage rectal cancers can sometimes be removed using an operation known as a local resection or a transanal resection. Using an endoscope, similar to the one used to take a biopsy, the surgeon removes only the cancer from the wall of the rectum. This operation is sometimes called transanal endoscopic microsurgery (TEM). If the cancer is close to the anus, the surgeon may be able to operate without the need for an endoscope. A pathologist will examine the cells of the cancer and if it’s then found to be high-grade| your surgeon may recommend that you have a second operation. This is done to remove more of the rectum to make sure that no cancer cells have been left behind.

Total mesorectal excision

Total mesorectal excision (TME) is an operation commonly used to remove a rectal cancer. It involves careful removal of the whole of the rectum as well as the fatty tissue that surrounds it, which contains the lymph nodes. This operation takes from 3–5 hours. Research has shown that a TME is better than other types of surgery at reducing the risk of the cancer coming back.

Depending upon the position of the cancer in the rectum, its size, and how far it is from the anus, your surgeon will do the TME operation by using either an anterior resection or an abdomino-perineal resection.

Anterior resection

An anterior resection is usually used for cancers in the upper and middle parts of the rectum (close to the colon). During the surgery, the piece of bowel that contains the cancer is removed and the two ends are then joined together. The join is known as an anastomosis.

The lymph nodes near the bowel are also removed, because this is usually the first place the cancer spreads to. After this operation you’ll have a wound that goes in a straight line from just below your breast bone (sternum) to just above your pelvis.

If for some reason the bowel can’t be rejoined, the upper end can be brought out onto the skin of the abdominal wall. This is known as a colostomy and the opening of the bowel is known as a stoma. A bag is worn over the stoma to collect the stool (bowel motions).

Sometimes a colostomy is only temporary and another operation to rejoin the bowel can be done a few months later. The operation to rejoin the bowel is known as stoma reversal. We can send you information about this.

If it isn’t possible to reverse the colostomy, the stoma is permanent. Having radiotherapy or chemoradiation before surgery can help to reduce the chance of needing a permanent colostomy.

Abdomino-perineal resection

An abdomino-perineal resection is usually used for cancers in the lower end of the rectum. This operation will result in a permanent colostomy because the whole rectum and anus are removed. After the surgery there will be two wounds – an abdominal wound and a second wound where the anus has been surgically closed.

Surgery for advanced rectal cancer Back to top

If the cancer is too large to be removed and is pressing on the bowel causing it to narrow, it may be possible to insert a thin metal tube (a stent) into the bowel to keep it open. The stent is inserted using a colonoscope| . You’ll be given a mild sedative to help you relax and you may have a short stay in hospital. 

Surgery may sometimes be used to remove the cancer when it has spread to another part of the body, such as the liver or lungs. Sometimes chemotherapy may be given before or after the surgery.

You may find our sections on  secondary cancer in the liver| and  secondary cancer in the lungs| helpful.