Abdominoperineal resection (APR) is a surgical procedure primarily used to treat colorectal cancer in the lower part of the rectum and anus.

This article provides an overview of APR, including its purpose, risks, effectiveness, and what to expect before, during, and after the surgery.

We’ll also discuss costs associated with APR and alternative treatments.

Doctors recommend APR to treat lower rectal and anal cancers that cannot be removed with less invasive surgeries.

During APR, a surgeon removes the rectum, anus, and sigmoid colon and creates a permanent colostomy to allow waste to leave the body.

This procedure is often used when cancer is close to the sphincter muscle (the muscle that keeps the anus closed) or the levator muscles that control urine flow.

Like any major surgery, APR comes with risks and potential side effects, some of which can last for a long time. Common long-term effects include:

Serious risks may include:

APR is an effective option for treating colorectal cancer in the lower rectum and anus.

The success of the surgery depends on several factors, including the stage of cancer and your overall health. However, this procedure also carries serious risks and long-term side effects.

For the best possible outcomes, it’s crucial to closely follow your doctor’s advice on follow-up care.

Here’s what to expect during your abdominoperineal resection procedure:

Before APR

Before the surgery, you will:

  • speak about your medical history with your surgeon
  • get several tests, such as blood and urine tests, imaging studies, and a physical exam, to ensure you’re healthy enough for surgery
  • meet with a stoma nurse to discuss your colostomy and its care
  • take antibiotics to minimize the risk of infection
  • shortly before surgery, drink a solution that will empty the colon

During APR

Your surgeon will use one of the following APR techniques:

During the surgery, which can last between 2 and 4 hours depending on the technique, the surgeon will:

  1. Make incisions in your abdomen and prepare the rectum, anus, and sigmoid colon for removal by separating blood vessels that serve these organs and freeing them from the rest of your intestine.
  2. Make incisions in the perineum (area between the legs) and remove the rectum, anus, and sigmoid colon, along with nearby lymph nodes and tissues, if necessary. This helps ensure that all cancerous tissue is removed.
  3. Close the incisions, including closing down the area where the anus used to be located, to prevent bowel incontinence.
  4. Create a permanent colostomy by bringing a part of the colon through a stoma in your abdomen and ensuring its proper placement. The surgical team will also check for any complications before completing the procedure.

After APR

After the surgery, you will likely stay several days in the hospital. During this time, you will:

  • receive pain management medications and antibiotics to prevent infection
  • learn how to care for the colostomy
  • begin a gradual return to eating solid foods

Preparing for APR involves several steps to ensure the surgery goes smoothly:

  • Follow the instructions provided by your care team. For example, they may recommend stopping drinking alcohol and smoking before the procedure.
  • Let your doctor know about all health conditions you have and medications you take, including vitamins and supplements.
  • Arrange for postsurgery care and support at home. This may involve coordinating with family members, friends, or professional caregivers.
  • Prepare emotionally for the changes that will come with a permanent colostomy. Counseling and support groups can provide valuable resources for coping with these changes.

In the first few weeks following APR, you will:

  • manage your pain and watch for signs of infection
  • adjust to the colostomy and learn proper stoma care
  • gradually increase physical activity

Long-term recovery includes:

  • regular follow-up appointments
  • ongoing stoma care and management
  • managing possible long-term side effects
  • seeking support from counseling or support groups, if needed

Depending on your cancer stage and location, other treatment options for colorectal cancer may include:

The cost of APR can vary widely based on factors like hospital charges, surgeon fees, and postsurgery care.

According to a 2019 study, this procedure can cost around $40,000. Most health insurance plans and government programs cover the cost of APR if it’s deemed medically necessary. Be sure to check your insurance plan to confirm that this procedure is covered.

It’s also important to consider the costs of ongoing care, such as supplies for the colostomy and follow-up appointments.

How serious is APR surgery?

APR is a major surgery, so it comes with significant possible risks and side effects. Doctors typically recommend it when less invasive treatments are not an option.

Is APR surgery necessary?

APR may be necessary if your cancer is located in a part of the rectum and anus that makes it impossible to preserve your bowel function.

APR is a surgical option for treating colorectal cancer in the lower rectum and anus. It’s an effective option, but it can come with risks, long-term side effects, and lifestyle changes due to permanent colostomy.

Be sure to let your doctor know if you have any questions about the effectiveness and safety of this procedure.