When APR is necessary
Tumours invading the sphincter complex or levator muscles, very low tumours with poor baseline continence, and recurrent or residual anal cancer after chemoradiotherapy. The decision follows MRI review and tumour board discussion, and is never taken lightly.
Technique
The abdominal phase mirrors total mesorectal excision. The perineal phase removes the anal canal with an appropriate cylinder of muscle to keep the margin clear, and the pelvic floor is reconstructed, occasionally with a flap. The colostomy site is marked with a stoma nurse before surgery.
Life with a permanent stoma
Pre-operative stoma education, siting and post-discharge nurse support are part of the pathway. Most patients return to work, exercise, travel and swimming.
Common questions
- Can the sphincter ever be saved instead?
- Where the tumour responds very well to chemoradiotherapy, sphincter preservation or a watch-and-wait strategy is sometimes possible and is reassessed on restaging MRI.
- How long is perineal wound healing?
- The perineal wound takes longer than abdominal ports — commonly four to eight weeks, longer after radiotherapy.
This page is general education, reviewed by Dr. Ishaan Allahabadi, MCh Surgical Oncology (Edge Hill, UK) · MS Surgery · MBBS (Accredited by the Royal College of Surgeons of England). It is not a substitute for individual medical advice. Treatment decisions are made after reviewing your imaging and pathology, in a multidisciplinary tumour board.