NCCN Guidelines for Patients
Rectal Cancer, Version 1.2017
Low anterior resection
esection) is used for tumors in the
mid to upper rectum. It includes a TME. In addition,
part of or your whole sigmoid colon is removed.
esection) is used for tumors
in the lower rectum. These tumors may have grown
into the anus or nearby muscle (levator ani). Some
can’t be removed with a cancer-free surgical margin.
APR requires a second cut into your skin between
your anus and genitals. This area is called the
perineum. A standard APR includes a TME and
removes the sigmoid colon and anus. An extended
APR may also remove the levator muscles.
Sometimes, less tissue is removed. The outer ring
of muscle in the anus may be spared. A colostomy,
described next, is needed.
Anastomosis and colostomy
An anastomosis is a type of surgery that connects
two parts of your bowel. It follows transabdominal
surgery. If your anus is fine, your colon may be
attached to it for near-normal bowel movements. This
is called a coloanal anastomosis.
A colostomy connects a part of the colon to the
outside of the abdomen. This creates an opening in
your abdomen. Stool can pass through the opening.
An enterostomal therapist may mark you at the best
spot for the colostomy.
This surgery may be done to allow your rectum to
heal before an anastomosis. Other people need a
colostomy because their anus was removed. In this
case, a colostomy is permanent.
Surgery to remove a metastasis is called a
metastasectomy. Not all metastatic disease can be
treated with surgery. The methods of surgery for
metastasectomy vary based on where the cancer
Overview of cancer treatments
Low anterior resection with
Surgery for most rectal cancers
removes the whole rectum.
Low anterior resection also
removes part of your colon.
Your remaining colon may be
connected to your anus for bowel
movements. This is called a
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