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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.


Figure 9


Abdominoperineal resection







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

has spread.


Overview of cancer treatments


Figure 9

Low anterior resection with

coloanal anastomosis

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

coloanal anastomosis.

Illustration Copyright © 2017 Nucleus Medical Media, All rights reserved.

coloanal anastomosis