Abdominoperineal resection (removing the rectum and anus)

An operation to remove the lower rectum, the anus and the back-passage muscles, usually for a very low cancer, leaving a permanent colostomy (stoma).

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

It removes the lower rectum, anus and back-passage muscles, usually for a very low cancer, and leaves a permanent colostomy.
Because the anus is removed, the bowel cannot be rejoined and the stoma is permanent.
There is a perineal wound (between the buttocks) that can be slow to heal, especially after radiotherapy.
It is part of MDT-planned cancer treatment; surgery alone does not guarantee a cure, and good stoma support matters a great deal.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeMajor bowel and pelvic operation

AnaestheticGeneral anaesthetic

How long it takesAbout 3–6 hours

Hospital stayUsually around a week or more

Time off workOften 8 weeks or more

When you'll see resultsPermanent colostomy; perineal wound and pelvis heal over weeks to months

On the NHS?Commonly done on the NHS as part of low rectal or anal cancer treatment

A general guide. Your surgeon will give you advice for your situation.

Best fit

Removes a low rectal or anal cancer that cannot be removed while keeping the back passage

Pause if

A cancer where the anus and its muscles can be safely preserved, so an anterior resection (no permanent stoma) may be possible instead.

Main recovery point

You recover on the ward, usually encouraged to sip fluids, eat lightly and get out of bed early. Pain is controlled with regular medicines; a tube may...

Good aftercare

An enhanced-recovery plan with clear advice on eating, moving, pain relief and return to activity.

First 24–72 hours

You recover on the ward, usually encouraged to sip fluids, eat lightly and get out of bed early. Pain is...

Days 3–7 (in hospital)

The stoma settles into a pattern and you begin learning to care for it with the stoma nurse. The perineal wound is...

Weeks 1–4 at home

Energy slowly returns. Walk little and often and avoid heavy lifting. The perineal wound is often still healing...

Weeks 6–12

Most people feel steadily stronger; lighter work is often possible. The perineal wound usually heals over this...

Medical line illustration of lower gi colonoscopy for Abdominoperineal resection (removing the rectum and anus). — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is an abdominoperineal resection (APR)?

An abdominoperineal resection (APR), sometimes called abdominoperineal excision or the Miles operation, removes the lower rectum, the anus and the surrounding back-passage muscles. It is used mainly for cancers very low in the rectum, or some anal cancers, where the tumour is too close to the anus to remove it while keeping a working back passage.

Because the anus and its muscles are removed, the bowel cannot be rejoined. The end of the colon is brought out onto the tummy wall as a permanent colostomy (a stoma with a bag). The operation is done through the tummy and also through the perineum (the area between the buttocks), so there is a wound there that needs time to heal.

APR is one part of treatment planned by a multidisciplinary team (MDT). Many people also have radiotherapy and/or chemotherapy before or after surgery. Surgery does not on its own guarantee a cure, so follow-up and any further treatment matter. Living with a permanent stoma is a big change, and good stoma support before and after surgery is an important part of care.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Open abdominoperineal resection

Through a cut in the tummy and a cut at the perineum. Used in many cases, especially for bulky or complex tumours or after scarring from previous treatment.

Laparoscopic (keyhole) APR

The abdominal part is done through small cuts with a camera where suitable, often meaning less pain and a quicker recovery from the abdominal wounds. The perineal part is still done from below.

Robotic-assisted APR

A form of keyhole surgery using robotic instruments, used in some specialist units. The choice depends on the surgeon, the tumour and your anatomy.

Extralevator APR (ELAPE)

A wider removal of the muscles around a low tumour, used to reduce the chance of leaving cancer behind in selected cases. It leaves a larger perineal wound that sometimes needs reconstruction.

APR with perineal reconstruction (flap)

When the perineal wound is large (often after radiotherapy or wide removal), tissue may be moved in (a flap) to help it heal. This adds to the size and recovery of the operation.

APR vs anterior resection

APR	Anterior resection
Removes the anus	Keeps the anus
Permanent colostomy	Bowel usually rejoined
Perineal wound to heal	No perineal wound
For very low cancers	For higher rectal cancers
No back-passage function	Bowel-control changes common

Which operation is right depends mainly on how low the cancer sits and whether the anus and its muscles can be safely preserved. The MDT and surgeon will explain why APR is advised for you. Both are major operations.

Preparing for your surgery

See the operating surgeon and discuss the MDT plan, including any radiotherapy or chemotherapy before surgery.
Have staging scans (such as MRI and CT) so the team knows exactly where the cancer is and why APR is needed.
Meet the stoma nurse, have a colostomy site carefully marked and learn what living with a permanent stoma involves.
Tell the team about all medicines, especially blood thinners, and about diabetes, heart or chest problems.
Stop smoking beforehand if you can — smoking strongly raises the risk of the perineal wound not healing.
Follow the unit's enhanced-recovery and preparation advice and get as fit as you can beforehand.
Arrange time off work (often 8 weeks or more), a lift home and help at home, as sitting and the perineal wound take time.

What happens

The operation is done under general anaesthetic, so you are asleep, and usually takes about 3 to 6 hours. The surgeon works through the tummy (by keyhole, robotic or open surgery) to free the lower colon and rectum, and through the perineum (the area between the buttocks) to remove the anus and back-passage muscles with the tumour.

The end of the colon is brought out onto the tummy wall as a permanent colostomy. The perineal wound is closed with stitches, and sometimes tissue is moved in (a flap) to help a large wound heal. A soft drain may be left for a short time.

Afterwards you recover on a ward, usually within an enhanced-recovery programme. Caring for the stoma and the perineal wound are important parts of early recovery, with stoma-nurse support. The removed tissue is examined in the laboratory; the results, discussed by the MDT, show the cancer stage and whether further treatment is advised.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

A cancer where the anus and its muscles can be safely preserved, so an anterior resection (no permanent stoma) may be possible instead.
You are not fit enough for a general anaesthetic and major pelvic surgery until other health problems are managed.
The MDT advises other treatment first, such as chemoradiotherapy, before any surgery (and some anal cancers are treated without surgery first).
Disease that has spread in a way the MDT feels surgery would not help, where other treatment is more appropriate.

Delay surgery if…

You have an active infection or are acutely unwell and need stabilising first.
Planned radiotherapy or chemotherapy before surgery is not yet completed.
Your blood-thinning medicine cannot yet be safely managed around surgery.
Important staging scans or results are not yet available to confirm APR is the right operation.
You have not yet met the stoma nurse or had a colostomy site marked.

Alternatives to discuss

Anterior resection or local removal for higher or earlier cancers where the anus can be preserved.
Chemoradiotherapy as the main treatment for many anal cancers, with surgery kept in reserve.
Radiotherapy and/or chemotherapy before surgery, which the MDT may advise to shrink the tumour.
Non-operative ('watch and wait') monitoring after a complete response to chemoradiotherapy in carefully selected people, within specialist services.
The NHS pathway rather than private care where speed is not the priority.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

General anaesthetic

You are fully asleep. This is standard for APR by keyhole, robotic or open surgery.

Epidural or spinal for pain relief

A regional injection in the back is often used alongside the general anaesthetic to help control pain, especially after open surgery.

Benefits

Removes a low rectal or anal cancer that cannot be removed while keeping the back passage
Removes the tumour with surrounding tissue and lymph nodes as part of treatment
Allows accurate staging of the cancer to guide any further treatment
A well-sited, well-supported colostomy lets most people return to normal activities over time
Avoids the poor bowel control that a very low join might otherwise cause

Risks & complications

More common

A permanent colostomy to adjust to and care for
A perineal wound that can be sore and slow to heal, especially after radiotherapy
Tiredness, pain and reduced appetite while you recover
Wound discomfort and a small risk of wound infection

Less common

Bleeding, sometimes needing a transfusion
Bladder or sexual problems from nerves near the rectum (such as erection or ejaculation changes, or vaginal dryness)
Chest or urine infection after surgery
Problems with the stoma, such as the surrounding skin, the stoma pulling in, or a hernia around it
Blood clots in the legs or lungs

Rare but serious

A perineal wound that does not heal (chronic wound) and needs ongoing care or further surgery
A collection of infection (abscess) in the pelvis needing drainage
Injury to nearby organs such as the ureter, bladder or small bowel
A perineal hernia (a bulge where the rectum used to be) later on
Serious problems related to the general anaesthetic, including very rarely a risk to life

There is no bowel join in an APR, so there is no anastomotic-leak risk — but the perineal wound can be slow to heal and sometimes does not heal well, especially after radiotherapy. The stoma is permanent, and nerves near the rectum can affect bladder and sexual function. Ask your surgeon about perineal-wound healing and what is done if it is slow, how your bladder and sexual function will be protected and reviewed, and what stoma support you will have.

Published figures to discuss

Risk depends on the tumour, whether radiotherapy was given beforehand, and your general health. There is no bowel join in an APR, so there is no anastomotic-leak risk, but perineal-wound problems are an important issue. The figures below are cautious ranges from surgical studies, not guarantees for any one person.

Figure	Reported range	How to interpret it	Source / confidence
Perineal wound complications	Reported in roughly a third to over half of cases in some series (about 35–60%), higher after radiotherapy	Includes infection, breakdown and delayed healing; some wounds become chronic. Source: perineal-wound healing reviews (PMC11377100 and related).	Perineal wound healing following abdominoperineal resection — review (PMC)ncbi.nlm.nih.govPublished figure
Chronic (non-healing) perineal wound	Reported in a notable minority in some series (for example, around 45% not fully healed by six months in one study)	More likely after radiotherapy, with smoking, diabetes, obesity or malnutrition. May need ongoing care or further surgery.	Abdominoperineal Resection — StatPearls (NCBI Bookshelf)ncbi.nlm.nih.govPublished figure
Bladder or sexual dysfunction	Urinary dysfunction is reported around 20–30% in some rectal-surgery series; sexual dysfunction is common and can be reported in about half or more of patients after rectal cancer surgery	Risk is higher with low pelvic surgery, radiotherapy, permanent stoma, previous dysfunction and nerve damage; ask how this will be assessed and supported.	Abdominoperineal Resection — StatPearls (NCBI Bookshelf)ncbi.nlm.nih.govPublished figure
Problems around the stoma (including a hernia around it)	Parastomal hernia is often reported around 25–50% over time after permanent/end colostomy, depending on follow-up and whether CT is used	May be managed with appliances, support garments or, sometimes, further surgery. Good siting and stoma care help but do not remove the risk.	Abdominoperineal Resection — StatPearls (NCBI Bookshelf)ncbi.nlm.nih.govPublished figure

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

APR is major pelvic surgery. Most people are in hospital for around a week or more and take 8 weeks or longer to feel back to normal. The perineal wound and getting used to a permanent stoma often take the longest, and sitting can be uncomfortable for a while.

First 24–72 hours

You recover on the ward, usually encouraged to sip fluids, eat lightly and get out of bed early. Pain is controlled with regular medicines; a tube may drain urine and the colostomy starts to work.

Days 3–7 (in hospital)

The stoma settles into a pattern and you begin learning to care for it with the stoma nurse. The perineal wound is checked. Many people go home around the end of the first week once comfortable and managing the stoma.

Weeks 1–4 at home

Energy slowly returns. Walk little and often and avoid heavy lifting. The perineal wound is often still healing; sitting on a cushion can help. You build confidence with stoma care.

Weeks 6–12

Most people feel steadily stronger; lighter work is often possible. The perineal wound usually heals over this time, though some take longer, particularly after radiotherapy.

Beyond 3 months

Recovery is usually well advanced and confidence with the stoma grows. A small number have ongoing perineal-wound or stoma issues that need continued support. Cancer follow-up continues as planned.

What's normal — and not a worry

A sore perineal wound and discomfort sitting for several weeks
Getting used to caring for a permanent colostomy
Tiredness for several weeks that slowly lifts
Reduced appetite and a bloated tummy in the early days
Some discharge from the healing perineal wound at first

Aftercare

Take painkillers as advised and keep moving little and often to lower clot and chest-infection risk.
Follow advice on caring for the perineal wound; sitting on a soft cushion can help comfort.
Use the stoma nurse's support to build confidence with colostomy care, and keep their contact details to hand.
Build up activity gradually and avoid heavy lifting until your surgeon says it is safe (to lower hernia risk).
Eat regular, balanced meals and follow any stoma-related dietary advice.
Do not drive until you can brake hard comfortably, are off strong painkillers and your insurer agrees.
Watch for warning signs such as a non-healing or infected perineal wound, fever or stoma problems.
Keep follow-up appointments and ask for your laboratory (pathology) results to be explained.

Before-surgery checklist

Painkillers in stock with a plan for taking them regularly
Stoma supplies and the stoma nurse's number ready
A soft cushion for sitting and help arranged at home for the first weeks
Loose, comfortable clothing and easy, balanced meals
Time off work booked (often 8 weeks or more)
Knowledge of warning signs (non-healing/infected perineal wound, fever, stoma problems)
The ward or clinic's contact number saved for problems

Scars and how they heal

There is a wound on the tummy (a few small scars plus a slightly larger one with keyhole or robotic surgery, or a longer cut with open surgery) and a wound at the perineum (between the buttocks). There is also a round colostomy site on the abdomen. The perineal wound can be slow to heal and may leave a firm scar; if a flap was used, there is an extra scar where the tissue came from. Scars are pink and firm at first and usually fade over months.

⚠ Get urgent help if…

A perineal wound that opens, leaks pus, smells offensive or becomes increasingly painful (possible infection)
Severe or worsening tummy or pelvic pain, or a hard, swollen, tender tummy
A high temperature, shivering or feeling very unwell
A colostomy that stops working, turns dark/dusky, or pulls in or bulges suddenly
Spreading redness, heat, swelling or discharge from any wound
A swollen, hot or painful calf, or breathlessness or chest pain (possible clot — call 999)
Heavy bleeding from a wound or the stoma

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

The aim of an APR is to remove a low rectal or anal cancer completely with a clear margin and the nearby lymph nodes. The laboratory results, discussed by the MDT, show the cancer stage and whether further treatment such as chemotherapy is advised.

Surgery cannot promise a cure, which is why follow-up and any further treatment matter. The trade-off for removing a very low cancer is a permanent stoma and a perineal wound that takes time to heal. With good stoma support, most people adapt and return to a full life over time. A good team is honest about both the cancer outlook and what living with a permanent colostomy involves.

How long it lasts

Long-term outcome after low rectal or anal cancer surgery depends mainly on the stage of the cancer, the quality of the surgery and any further treatment. Follow-up scans and blood tests over several years aim to pick up any return early. The colostomy is permanent; most people manage it well with support, although stoma-related issues such as skin problems or a hernia around the stoma can develop over time and may need attention. A perineal hernia is uncommon but can appear later.

Combining with other procedures

APR is part of a wider cancer treatment plan rather than a one-off operation. Many people have radiotherapy and/or chemotherapy before or after surgery, decided by the MDT. Perineal reconstruction (a flap) may be done at the same time when the wound is large. You should not feel pressured into unrelated add-on procedures.

Follow-up & long-term care

You will be reviewed after surgery to check the wounds and stoma and to explain the laboratory (pathology) results. NICE advises regular follow-up in the first years with blood tests (including the CEA tumour marker) and CT scans to look for any return. The perineal wound is monitored until healed, and you will have ongoing stoma-nurse support. You should always be told who to contact for problems with the wound, stoma or other concerns.

Attend all follow-up appointments and surveillance scans after cancer surgery.
Keep up colostomy care and stoma reviews, and seek help early for skin or stoma problems.
Build back up to normal activity and lifting gradually to lower the risk of a hernia around the stoma.
Report any non-healing perineal wound, new bulge, bleeding or change in symptoms promptly.
Access psychological and practical support for adjusting to a permanent stoma if you need it.
Stop smoking and keep to a healthy weight to support healing and general health.

Revision and secondary surgery reality

A non-healing perineal wound may need ongoing dressings, specialist wound care or, sometimes, further surgery such as a flap.
A hernia around the stoma can develop and may need a support garment or repair.
A perineal hernia (a bulge where the rectum used to be) is uncommon but can need repair.
The colostomy is permanent and cannot be reversed.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

An enhanced-recovery plan with clear advice on eating, moving, pain relief and return to activity.
Structured monitoring and care of the perineal wound until it heals, with a plan if it does not.
A named contact and out-of-hours number, with clear warning signs for wound infection, stoma or bowel problems.
Ongoing stoma-nurse support and access to psychological support for adjusting to a permanent stoma.
Explanation of the laboratory (pathology) results and the MDT follow-up schedule, with review of bladder and sexual function.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

Keyhole, robotic or open approach and the complexity of your case
Whether perineal reconstruction (a flap) is needed
Surgeon's and anaesthetist's fees
Theatre/facility time and length of hospital stay
Permanent stoma supplies and ongoing stoma-nurse support
Any radiotherapy or chemotherapy before or after surgery (separate treatment)
Follow-up appointments, surveillance scans and the policy if a complication occurs

Make sure your written quote includes

The surgeon's fee and the anaesthetist's fee
The hospital/facility and theatre fee, and the expected length of stay
Whether any perineal reconstruction (flap) is covered
Permanent stoma supplies and stoma-nurse support, before and after surgery
Pre-operative scans and explanation of laboratory (pathology) results
Follow-up appointments and cancer surveillance scans
What happens, and who pays, if there is a complication such as a non-healing perineal wound or a longer stay

On the NHS? Abdominoperineal resection is widely available on the NHS as part of low rectal or anal cancer treatment and is normally arranged promptly through the multidisciplinary team; private care may be chosen for speed or choice of surgeon, but cancer surgery is usually organised quickly on the NHS.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

Why is an APR (with a permanent stoma) advised rather than an operation that keeps my back passage?
How will my colostomy be sited, and what stoma support will I have before and after surgery?
How is the perineal wound managed, and what happens if it is slow to heal?
How will my bladder and sexual function be protected and reviewed?
Will I need radiotherapy or chemotherapy before or after the operation?
What follow-up will I have to check the cancer has not come back?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Will I definitely have a permanent stoma?

Yes. Because an APR removes the anus and back-passage muscles, the bowel cannot be rejoined, so the colostomy is permanent. Careful siting before surgery and good stoma-nurse support help most people adjust and return to a full life.

Why can't the surgeon just keep my back passage?

APR is used when a cancer is too close to the anus to remove it while leaving a working back passage with a clear cancer margin. If the anus could be safely preserved, a different operation (such as anterior resection) would usually be offered instead. The MDT decides based on where the cancer sits.

Why is there a wound between my buttocks, and why is it slow to heal?

Part of the operation is done through the perineum to remove the anus. This perineal wound can be slow to heal, especially after radiotherapy, and sometimes needs extra care or, occasionally, further surgery. Not smoking and good wound care help.

Can this be done on the NHS?

Yes. APR is commonly done on the NHS as part of low rectal or anal cancer treatment, usually arranged promptly through the MDT. Private care may be chosen for speed or choice of surgeon, but cancer surgery is normally organised quickly on the NHS.

Could the surgery affect bladder or sexual function?

It can, because important nerves run close to the rectum. Surgeons take care to protect them, but changes such as erection or ejaculation problems, or vaginal dryness, can happen. This should be discussed beforehand and reviewed afterwards, with help available.

Does surgery cure the cancer?

Surgery aims to remove the cancer completely, but it cannot promise a cure. Outcome depends on the stage of the cancer and any further treatment. This is why the MDT plans your care and why follow-up scans and blood tests continue for several years.

Find a verified surgeon for abdominoperineal resection (removing the rectum and anus)

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

No verified consultants list this procedure yet — browse the full directory.

See all surgeons for abdominoperineal resection (removing the rectum and anus) →

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NICE NG151 — Colorectal cancer (recommendations) Bowel Cancer UK — Surgery Abdominoperineal Resection — StatPearls (NCBI Bookshelf) Perineal wound healing following abdominoperineal resection — review (PMC) Perineal repair after abdominoperineal excision with rectus abdominis myocutaneous flap (PMC) Urinary and sexual dysfunction after rectal cancer surgery — review (PMC) Parastomal hernia after abdominoperineal resection — Frontiers in Oncology NHS — Bowel cancer treatment

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.