Types of surgery for rectal cancer
Information on rectal cancer (sometimes called colorectal cancer), including how it is diagnosed, treatments, and possible side effects.
Total mesorectal excision (TME)
Most people with rectal cancer have a TME as part of their surgery. A TME is when the surgeon removes some of the fatty tissue around the rectum (mesorectum).
The fatty tissue contains lymph nodes and blood vessels. This means all the lymph nodes near to the tumour are removed, which reduces the risk of the cancer coming back. If possible, the surgeon joins the colon to the top of the anus.
In the illustration, the black dotted line shows an example of the tissue that may be removed during a TME operation.
A diagram of the large bowel and mesorectum
Anterior resection
Rectal cancers in the upper and middle part of the rectum can be removed by an operation called an anterior resection. The surgeon removes the part of bowel that contains the cancer, then re-joins the two open ends of bowel. The illustrations show the part of the bowel that is removed, and how the two ends are joined together. This operation is also called a low anterior resection (LAR).
You may have a temporary stoma (usually an ileostomy) after this operation. You can usually have a stoma reversal a few months later.
A diagram of an anterior resection
A diagram of anterior resection re-joined
Colo-anal and J-pouch surgery
If the cancer is low in the rectum, the surgeon may use an operation called a colonic J-pouch. This is used to join the bowel to the anus. It is a type of reconstructive surgery. The surgeon makes a pouch, called a J-pouch, from part of the colon, before joining it to the anus. The pouch acts like a new rectum and stores stools (poo) until it is convenient to pass them. The illustration shows a J-pouch.
You may have a temporary stoma (usually an ileostomy) after this operation This allows the bowel to heal. You can usually have a stoma reversal a few months later.
A diagram of a J-pouch
Abdomino-perineal resection (APR)
If the cancer is very close to the anus, you may need an operation called an abdomino-perineal resection. This is when the surgeon needs to remove the rectum and anus, to remove all the cancer. You will have a permanent stoma (usually a colostomy) after this operation.
As well as the wound on your tummy, you will have a wound on your bottom where the anus has been closed. The anus may be closed using muscle, fat and skin from another part of the body. This is called a flap. This operation can be done as either keyhole (laparoscopic) surgery or open surgery, depending on the size of the tumour.
A diagram of abdominal perineal resection
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References
Below is a sample of the sources used in our rectal cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
R Glynne-Jones, PJ Nilson, C Aschele et al. ESMO-ESSO-ESTRO Clinical practice guidelines for diagnosis, treatment and follow up for anal cancer. July 2014. European Society of Medical Oncology. Available from www.esmo.org/Guidelines/Gastrointestinal-Cancers/Anal-Cancer (accessed October 2019).
National Institute for Health and Excellence (NICE). Colorectal cancer: diagnosis and management clinical guidelines. Updated December 2014. Available from www.nice.org.uk/guidance/cg131 (accessed October 2019).
Association of Coloproctology of Great Britain & Ireland (ACPGBI). Volume 19. Issue S1. Guidelines for the management of cancer of the colon, rectum and anus. 2017. Available from www.onlinelibrary.wiley.com/toc/14631318/19/S1 (accessed October 2019).
National Institute for Health and Care Excellence. Preoperative high dose rate brachytherapy for rectal cancer. 2015. Available from www.nice.org.uk/guidance/ipg531 (accessed October 2019).
BMJ. Best practice colorectal cancer. Updated 2018. Available from www.bestpractice.bmj.com/topics/en-gb/258 (accessed October 2019).
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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