Surgery for rectal cancer
The type of operation you need will depend on the stage of the cancer and where it is in the rectum.
Rectal cancer surgery
Surgery is the most common treatment for rectal cancer. You may have other treatments before surgery to make it easier to remove the cancer. You could have 1 of the following treatments:
- radiotherapy
- chemotherapy
- chemotherapy and radiotherapy together which is called chemoradiation.
Treatment before surgery also lowers the risk of the cancer coming back in the rectum or the tissues close to it.
There are things you can do before surgery to help you to improve your fitness.
Bowel cancer is a general term for cancer that starts in either the colon or rectum. It might sometimes be called colorectal cancer.
Surgery to the bowel (colon) is different from surgery to the back passage (rectum).
In the video below, Oncologist Rebecca and Cancer Nurse Specialist Claire explain how bowel cancer may be treated. They talk about surgery, chemotherapy, radiotherapy, immunotherapy and targeted therapies.
We understand that having treatment can be a difficult time for people. We are here to support you. If you want to talk, you can:
- call the Macmillan Support Line for free on 0808 808 00 00
- chat to our specialists online
- visit our bowel (colon and rectal) cancer forum to talk to people who have been affected by bowel cancer, share your experience, and ask an expert your questions.
Before your operation
Before your operation, you go to a pre-assessment clinic to check you are fit for the operation. At the clinic, you may have blood tests, a blood pressure check and a recording of your heart (ECG).
For some types of rectal cancer surgery, your bowel needs to be empty. A nurse may advise you about preparing for your operation. You may need to follow a special diet. You may need to take a laxative for a few days before the operation. You will also be asked not to eat or drink for a few hours before the operation.
Before the operation, you will usually be given antibiotics. These are to prevent infection. You may have them as an injection or tablets.
You will meet a member of the surgical team to discuss the operation. If you are going to have a stoma, you will also meet a stoma care nurse, who will explain what is involved.
During your clinic appointment, you can ask questions or share any concerns you have about the operation. If you live alone, or care for someone else, you may need help when you go home after surgery. Tell a nurse as soon as possible. They can help to make arrangements for you. We have more information about getting support at home after leaving hospital.
You will usually go into hospital on the morning of the operation. You will be given elastic stockings (TED stockings) to wear during the operation and for some time afterwards. This is to prevent blood clots in your legs.
Related pages
Surgery to remove rectal cancer
There are different types of surgery for rectal cancer. The type or surgery you have will depend on:
- the stage of the cancer
- where it is in the rectum
- your general health.
Surgery to remove part or all of the rectum is called a resection.
After the operation, all the tissue that the surgeon has removed is sent to a pathologist. They check it carefully to see whether there are cancer cells close to the edge. The edge is called the margin.
If the pathologist finds cancer cells in the margin, there might be a higher risk of the cancer coming back. This is not common, but if it happens you may be offered a second operation or radiotherapy.
Related pages
Surgery for early stage rectal cancer
If you have a very small, stage 1 rectal cancer, you may have an operation called a local excision. This is a small operation to remove the cancer and some of the healthy tissue surrounding it. The cancer can usually be removed through the anus. This means the surgeon does not have to make a cut in your tummy.
There are 2 ways your surgeon can do this.
Transanal endoscopic microsurgery (TEM)
The surgeon passes a long, flexible tube into the anus and the rectum. The tube is called an endoscope. It has a light and camera on the end. This allows the surgeon to find the tumour and remove it precisely.
Transanal minimally invasive surgery (TAMIS)
The surgeon places a small port into the anus. A port is a circular device that holds the anus open. This allows the surgeon to see the rectum clearly. The surgeon then passes a laparoscope and other instruments through the port into the rectum to remove the cancer.
Surgery for locally advanced rectal cancer
If you have locally advanced rectal cancer, the type of surgery you have depends on:
- where the cancer is in the rectum
- the size of the tumour
- how far it is from the anus.
Open or laparoscopic surgery
Your operation may be done as either:
- open surgery
- keyhole surgery which is also called laparoscopic surgery.
Open surgery
Open surgery means the surgeon makes 1 large cut, usually near the tummy button. The length of the cut depends on the size of the cancer and where it is.
Laparoscopic (keyhole) surgery
Laparoscopic surgery means the surgeon makes 4 or 5 small cuts in the tummy. They pass a thin tube through 1 of the cuts. The tube is called a laparoscope. It has a small camera on the end. The surgeon then passes specially designed surgical tools through the other cuts. The surgeon uses these tools to remove the cancer.
Laparoscopic surgery is also sometimes called minimally invasive surgery. You usually recover more quickly from it than from open surgery.
Robotic surgery
Robotic surgery is when laparoscopic surgery is helped by a machine. The laparoscope and the surgical equipment are attached to robotic arms. The surgeon controls the robotic arms, which can move very precisely. This is very specialised surgery and only available in some hospitals in the UK.
Your surgeon will talk to you about which type of surgery is likely to be best in your situation.
Stomas (colostomy or ileostomy)
Sometimes during surgery to remove the cancer, the surgeon needs to create a stoma. This is an opening the surgeon makes through the tummy (abdominal) wall. It connects the bowel to the surface of the tummy.
Having a stoma means stools (poo) and wind will not pass out of the rectum and anus in the usual way. Instead, they will pass out of the stoma, into a disposable bag you wear over the stoma.
If the stoma is made from an opening in the colon, it is called a colostomy. If it is made from an opening in the small bowel (ileum), it is called an ileostomy.
Stomas may be temporary or permanent.
The surgeon may make a temporary stoma to allow the bowel to heal after surgery. If you have a temporary stoma, you will usually have an operation to close the stoma and rejoin the bowel after you have finished your treatment. This operation is called a stoma reversal.
If the cancer is very low in the rectum and close to the anus, you are more likely to need a permanent stoma.
Your surgeon will tell you whether you are likely to have a stoma, and whether it will be temporary or permanent. If you need to have a stoma, you will be referred to a nurse who specialises in stoma care. They can talk to you about what to expect.
We have more information on stomas.
Anterior resection
If you have cancer in the upper or middle part of the rectum, you may have an operation called an anterior resection or low anterior resection (LAR). The surgeon removes the part of bowel that contains the cancer. They then rejoin the 2 open ends of bowel. The diagrams show the part of the bowel that is removed, and how the 2 ends are rejoined.
You may have a temporary stoma after this operation. This is usually an ileostomy. You can usually have a stoma reversal a few months later.
Anterior resection
Anterior resection rejoined
Abdominal perineal resection (APR)
If the cancer is very close to the anus, you may need an operation called an abdominal 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 after this operation. This is usually a colostomy.
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. It depends on the size of the tumour.
Abdominal perineal resection
Total mesorectal excision (TME)
As well as removing the cancer using one of the operations mentioned, many surgeons also remove some of the fatty tissue around the rectum. This contains lymph nodes and blood vessels. The fatty tissue is called the mesorectum. The operation to remove it is called a total mesorectal excision (TME).
Surgery for advanced rectal cancer
There are different types of surgery for advanced rectal cancer. This will depend on where the cancer has spread to. Your cancer doctor will explain whether surgery is suitable for you.
Some people might need surgery if the cancer is causing a blockage in the bowel.
If rectal cancer has spread to the liver or lungs, surgery might be suitable for some people. Sometimes a liver resection to remove secondary liver tumours may be done at the same time as surgery to remove the cancer in the rectum.
If the cancer has grown into other organs nearby some people might need to have some of the organs in their pelvis removed. This operation is called a pelvic exenteration. It is not suitable if the cancer has spread to organs in other parts of the body.
We have more information about treating advanced bowel cancer.
After your operation
Your nurse will explain what to expect after your operation.
When you are ready they will help you to get out of bed or to sit up for a short time. You are likely to have a drip into your arm to give you fluids until you are eating and drinking again. You may have a tube in your tummy, close to the wound to drain fluid into a small drainage bag or bottle.
Your recovery time will depend on whether you had open or keyhole surgery.
We have more information on recovering after bowel cancer surgery.
Booklets and resources
About our information
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.
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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
informationproductionteam@macmillan.org.uk
National Institute for Health and Care Excellent (NICE). Colorectal cancer. NICE guideline [NG151]. Updated December 2021. Available from: www.nice.org.uk/guidance/NG151 [accessed Jan 2023].
Cervantes A, Adam R, Rosello S, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology. 2023 ;34(1):10-32. Available from: www.annalsofoncology.org [accessed Jan 2023].
Sanoff HK. Improving treatment approaches for rectal cancer. New England Journal of Medicine. 2022;386(25); 2425–2426. Available from: www.doi.org/10.1056/NEJMe2204282 [accessed Jan 2023].
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