Surgical options for rectal cancer

What is rectal cancer surgery, and why is it necessary?

Rectal cancer surgery involves removing the tumour along with adjacent tissue. The aim is to eliminate cancerous tissue, prevent spread, and relieve symptoms such as bleeding, obstruction or pain. The specific approach depends on the tumour's location, size and stage.

What are the types of surgery?

• Local excision: for small, early-stage tumours near the anus — the tumour and minimal surrounding tissue are removed through the anus, without major incisions.
• Low anterior resection (LAR): for tumours in the upper or middle rectum; the affected section is removed and the colon reconnected, preserving normal bowel function.
• Abdominoperineal resection (APR): for lower rectal cancers near the anus; the rectum, anus and surrounding tissue are removed and a permanent colostomy created.
• Total mesorectal excision (TME): a precise technique removing the rectum with its adjacent lymph nodes, often combined with LAR or APR.
• Minimally invasive approaches: laparoscopic or robotic surgery, with smaller incisions, faster recovery and less discomfort.

When is chemotherapy or radiation needed?

Neoadjuvant therapy — radiation and chemotherapy before surgery — often precedes the operation in locally advanced rectal cancer, shrinking the tumour and reducing recurrence risk. Adjuvant therapy afterwards may follow if cancer cells are found in lymph nodes or at the tissue margins.

What can I expect during recovery?

• Hospital stay: typically 3–7 days after major rectal surgery.
• Pain management: medication controls discomfort, which diminishes as healing progresses.
• Bowel function: frequent movements or incontinence are common afterwards, and usually improve with time and pelvic floor rehabilitation.
• Diet: begin with soft, low-fibre food, reintroducing normal food gradually.
• Activity: light walking early; avoid heavy lifting for several weeks.

What is a colostomy, and will I need one?

A colostomy creates an opening in the abdominal wall — a stoma — allowing waste to exit into a collection bag. It may be temporary, to let the rectum heal, or permanent where the anus and rectum have been removed. Specialised stoma nurses provide management guidance.

What are the risks?

• Bleeding or infection at the surgical site.
• Leakage where the colon and rectum are reconnected.
• Changes in bowel function, such as diarrhoea or incontinence.
• Nerve damage affecting bladder or sexual function.
• Adhesions or obstruction.

How is life after surgery?

• Bowel habits: stabilisation takes time; pelvic floor exercises and medication assist.
• Diet: long-term adjustment may be needed for diarrhoea or bloating.
• Emotional impact: colostomy management and changed bowel habits present real psychological challenges; support groups and counselling help.
• Follow-up: lifelong monitoring with colonoscopy, imaging and CEA blood tests.

Can rectal cancer be cured with surgery alone?

Early-stage rectal cancer confined to the rectum without lymph node involvement may be cured by surgery alone. Advanced stages benefit most from surgery, chemotherapy and radiation combined. Early detection and treatment optimise the outcome.