Surgery for anal cancer

This surgery only removes the area of the anus containing the cancer cells. It is sometimes used to treat small, early-stage cancers in the anal margin.

This operation will not usually affect the anal sphincter. This means you will not have long-term problems with bowel control afterwards.

Your doctors may recommend you have radiotherapy or chemoradiation after surgery. This is usually if there are some cancer cells in the tissue close to where the cancer was removed.

This surgery removes the anus, rectum and part of the colon. Doctors usually only advise having an APR if:

• chemoradiation has not removed all the cancer
• the cancer has returned after treatment.

This operation can be done as either keyhole (laparoscopic) surgery or open surgery. This depends on the size of the tumour.

As well as the wound or wounds 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.

You will have a permanent stoma (colostomy) after this operation. This can be upsetting and it may take time to adjust to. Your surgeon and a stoma nurse specialist will talk to you before the operation to help you prepare. You can ask them any questions. Your nurse will give you lots of support, and there are organisations that can help. We have more information about having a stoma, including organisations that can help.

Abdominal perineal resection

Stoma and stoma bag (colostomy)

Before chemoradiation, some people may need to have an operation to create a stoma.

You may have a stoma to relieve symptoms in the following situations:

• The cancer is causing you to have problems controlling your bowel. This is called incontinence.
• There is an abnormal opening between the bowel and skin. An abnormal opening between 2 areas of the body is called a fistula.
• There is a fistula between the bowel and another organ, such as the bladder or vagina.
• There is a risk of a fistula forming.
• The cancer is causing a blockage in the bowel (bowel obstruction).

After you have finished chemoradiation, your doctors will assess you to decide whether you can have the stoma reversed. This will mean you can pass stools through the anus again. It is not always possible to reverse the stoma.

After your operation, you will be encouraged to start moving around as soon as possible. Even if you have to stay in bed, it is important to do regular leg movements and deep-breathing exercises. A physiotherapist or nurse will explain these to you.

To reduce the risk of blood clots, you will wear TED stockings. Your nurse may also give you medication to prevent blood clots, as injections under the skin.  

After your operation, a nurse will usually help you to get out of bed or to sit up for a short time. Gradually, you will be able to sit or stand up for longer, and to start walking around the ward.

It is normal to have some pain or discomfort for a few days after surgery. This can be controlled with painkillers. Immediately after your operation you may have painkillers in the following ways:

• By mouth (orally).
• As an injection. 
• Through an epidural. This is a small, thin tube in your back that goes into the space around your spinal cord. It gives you continuous pain relief. 
• Through a patient-controlled analgesia pump (PCA pump). The pump is attached to a fine tube (cannula) in a vein in your arm. You control the pump using a handset that you press when you need more of the painkiller. 
• Through a thin tube called a rectus catheter that your surgeon places in your tummy. You may have this kind of catheter if you have the cut downwards from your belly button to your tummy. 
• A combination of some of the above.

It is important to tell your doctor or nurse if the pain is not controlled. They can change your painkillers.

Painkillers sometimes slow down your bowel function (cause constipation). If your bowels are not moving, tell your nurses. They can give you medicines to help.  

After an APR, it may be uncomfortable to sit down. This will improve as the wound heals. You may be given a special cushion to help make you feel more comfortable.

Before you can go home, your pain needs to be controlled by tablets. You will get a prescription for painkillers you can take at home as needed.

Your wounds may be closed with stitches, clips or staples. A nurse at your GP surgery usually removes these after you go home. Sometimes a district nurse can come to your home to remove them. Some surgeons use dissolving stitches. These do not need to be removed.

Sometimes your surgeon may use a flap of tissue to close the wound, instead of stitches or clips. This is more likely if you have already had radiotherapy. If you have a flap, you will not be able to sit on your bottom for 2 to 4 days after your operation. This is to reduce pressure on your wound and help it heal.

You will only be able to sit for short periods at first. As things improve, you can slowly increase this. You can lie on your side but will still need to change your position regularly. Your doctor or nurse will give you advice about how often to change position when sitting.

You may be given antibiotics to help prevent any wound infection. While you are in hospital and after you go home, tell your nurse or doctor straight away if your wound: 

• becomes hot
• becomes painful
• bleeds
• leaks any fluids.

These can be signs that the wound is infected.