Procedure · GI Oncology

Rectal cancer surgery, sphincter-saving where possible

Total mesorectal excision · Apollo Speciality Hospitals, Nellore

Rectal cancer surgery has been transformed by total mesorectal excision (TME), neoadjuvant chemoradiotherapy, and minimally invasive approaches. The priority is curative oncological resection with the lowest possible chance of local recurrence, and, where the tumour permits, preservation of the anal sphincter to avoid a permanent stoma. Dr. Dwarakanath Reddy performs rectal cancer surgery at Apollo Speciality Hospitals, Nellore, with full multidisciplinary backing.

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01 · GI Oncology

What is rectal cancer surgery?

Rectal cancer surgery removes the rectum along with its surrounding mesorectum (TME, total mesorectal excision), the lymphatic and vascular package that contains microscopic disease. The choice of operation, low anterior resection (LAR) with restoration of intestinal continuity, or abdominoperineal resection (APR) with permanent colostomy, depends on the tumour's distance from the anal verge, response to neoadjuvant therapy, and pre-operative sphincter function. Many patients receive chemoradiotherapy before surgery to shrink the tumour and reduce recurrence risk.

02 · GI Oncology

Conditions treated

Surgery is offered for:

Rectal adenocarcinoma, the great majority of rectal cancers
Locally advanced rectal cancer after neoadjuvant chemoradiotherapy
Recurrent rectal cancer suitable for re-resection
Selected rectal neuroendocrine tumours
Large or symptomatic rectal villous adenomas not amenable to endoscopic resection
Rectal GIST tumours

Workup includes high-resolution rectal MRI (the most important staging investigation), PET-CT or contrast CT for distant staging, colonoscopy to map the entire colon, and tumour markers (CEA). All cases are discussed in a multidisciplinary tumour board before treatment is finalised.

03 · GI Oncology

How a low anterior resection (LAR) with TME is performed

01 Open or laparoscopic approach under general anaesthesia, preceded by neoadjuvant therapy in most cases
02 Mobilisation of the splenic flexure to allow tension-free anastomosis later
03 Ligation of the inferior mesenteric artery and vein at their origins (high tie)
04 Sharp dissection along the holy plane, removing the rectum together with its intact mesorectum (TME)
05 Distal division at least 1 to 2 cm below the tumour for adequate margin
06 Stapled colorectal or coloanal anastomosis to restore continuity
07 Defunctioning loop ileostomy in most low-rectal cases (reversed 8 to 12 weeks later)
08 Drains placed; abdomen closed in layers

For very low tumours close to the anal canal where sphincter preservation is unsafe, abdominoperineal resection (APR) is performed instead, with permanent end colostomy. Total operating time is 4 to 7 hours.

04 · GI Oncology

Recovery timeline

Day of surgery	Inpatient ICU or HDU. NPO. Drain monitoring.
Day 1 to 3	Walking by day one. Sips of clear fluid by day two. Stoma teaching begins for patients with a temporary or permanent stoma.
Day 4 to 10	Soft diet, gradual progression. Discharge typically around day 7 to 12.
Week 2 to 6	Wound healing, bowel adjustment. Office work in 4 to 6 weeks.
Month 3 onward	Adjuvant chemotherapy if indicated by histopathology. Stoma reversal scheduled at 8 to 12 weeks for those with a defunctioning loop. Surveillance every 3 months for 2 years.

Bowel function after low anterior resection takes time to settle (low anterior resection syndrome). Frequency, urgency, and incomplete evacuation are common in the first 6 to 12 months and usually improve with pelvic floor exercises and diet adjustments.

05 · GI Oncology

Risks and complications

Rectal cancer surgery is major. Specific risks include anastomotic leak (5 to 10 percent, the most concerning early complication, often mitigated by a defunctioning ileostomy), bleeding, pelvic abscess, urinary and sexual dysfunction (particularly after low rectal cancer surgery), wound complications, and changes in bowel function. For cancer surgery, oncologic completeness, clear circumferential resection margin and adequate lymph node yield, is the priority. Dr. Reddy discusses procedure-specific risk in detail before consent.

06 · GI Oncology

Why Dr. Reddy for rectal cancer surgery

DrNB qualified surgical gastroenterologist with GI oncology focus
TME with sharp dissection along the holy plane, gold standard for local recurrence prevention
Pre-operative MRI-based planning for every case
Sphincter-saving approach where the tumour position permits
Tumour board format discussion before treatment plan is finalised
Coordination with radiation oncology and medical oncology for neoadjuvant and adjuvant therapy

07 · GI Oncology

Frequently asked questions

Will I need a stoma after rectal cancer surgery?

Most low rectal cancer patients will have a temporary defunctioning ileostomy that protects the new join while it heals. This is reversed 8 to 12 weeks later. A permanent stoma (after APR) is needed only for very low tumours where sphincter preservation is unsafe, around 10 to 20 percent of cases in modern practice.

What is neoadjuvant therapy and why is it given?

Neoadjuvant means treatment before surgery. For locally advanced rectal cancer (T3, T4, or with positive lymph nodes), chemoradiotherapy is given first to shrink the tumour, reduce local recurrence risk, and sometimes allow sphincter-saving surgery that would otherwise be impossible. The treatment lasts 5 to 6 weeks; surgery follows 8 to 12 weeks later.

Can rectal cancer be treated laparoscopically?

Yes. Both laparoscopic and open TME are oncologically equivalent in randomised trials, with faster recovery for the laparoscopic approach. The choice depends on tumour size, prior surgery, and patient anatomy. Robotic and TaTME (transanal TME) are alternatives in selected cases.

What is the survival rate for rectal cancer?

Stage dependent. Stage I has excellent five-year survival above 90 percent. Stage II is around 70 to 85 percent. Stage III is around 50 to 70 percent depending on lymph node burden. Stage IV (distant metastases) varies widely depending on whether metastases are resectable. Modern multimodal treatment has substantially improved outcomes at every stage.

Will my insurance cover this surgery?

Yes. Cancer surgery is universally covered. Pre-authorisation is straightforward, send your reports on WhatsApp for an estimate.

Related conditions

Conditions this procedure treats.

ICD-10 · C18-C20

Colorectal Cancer

Cancer of the colon or rectum. The fourth most common cancer worldwide. Curative-intent surgery, often combined with chemotherapy and radiation, is the standard of care for resectable disease.

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Next step

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