Anterior resection (removing part of the rectum) (Anterior resection of the rectum)

An operation to remove part of the rectum (back passage) and the lower colon, usually for a cancer, then join the bowel back together so the back passage can still be used.

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

In short

It removes part of the rectum (usually for cancer) but keeps the anus, so the bowel is normally rejoined.
A temporary stoma is often made to protect the new join, and is usually reversed later; a minority need a permanent one.
Bowel habit often changes a lot afterwards (low anterior resection syndrome), which can take many months to settle and may not fully resolve.
It is part of MDT-planned cancer treatment; surgery alone does not guarantee a cure, and the main serious risk is the join leaking.

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

At a glance

TypeMajor bowel and rectal operation

AnaestheticGeneral anaesthetic

How long it takesAbout 3–5 hours

Hospital stayUsually around a week, sometimes longer

Time off workOften 6–8 weeks or more

When you'll see resultsBowel function changes for months; final result depends on the cancer and the join

On the NHS?Commonly done on the NHS as part of bowel (rectal) cancer treatment

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

Best fit

Removes the rectal cancer with surrounding tissue and lymph nodes as part of treatment

Pause if

A cancer so low that the anus cannot be safely preserved, where an abdominoperineal resection (permanent stoma) may be advised 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 bowel or stoma begins working and you build up eating and moving. Many people go home around the end of the...

Weeks 1–4 at home

Energy slowly returns. Walk little and often, avoid heavy lifting and build activity gradually. If you have a...

Weeks 6–12

Most people feel steadily stronger; lighter work is often possible. A temporary stoma may be reversed around now...

Medical line illustration of lower gi colonoscopy for Anterior resection (removing part of the rectum). — 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 anterior resection?

An anterior resection removes part of the rectum (the last part of the bowel, the back passage) along with the lower colon, usually because of a cancer in the rectum. The surgeon removes the tumour with a clear margin and the surrounding fatty tissue and lymph nodes (an approach called total mesorectal excision in lower tumours).

Unlike some other rectal operations, an anterior resection keeps the anus (the muscle that controls the back passage), so the bowel is usually joined back together and you can still pass stool the normal way. The lower the cancer sits, the more delicate the surgery and the more it can affect how the bowel works afterwards.

Many people have a temporary stoma (often a loop ileostomy) made higher up to protect the new join while it heals. This is usually reversed by a smaller operation weeks or months later. A minority need a longer-term or permanent stoma.

Rectal cancer surgery is one part of treatment planned by a multidisciplinary team (MDT). Some people also have radiotherapy or chemotherapy before or after surgery. Surgery does not on its own guarantee a cure, and bowel habit afterwards can be very different — a pattern called low anterior resection syndrome (LARS) is common.

Types & techniques

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

Low anterior resection (LAR)

For cancers lower in the rectum. More of the rectum is removed and the join sits low down, which more often affects bowel control afterwards and usually involves a temporary stoma.

High anterior resection

For cancers or disease higher up, near where the colon meets the rectum. The join sits higher, often with less effect on bowel control and sometimes no stoma.

Laparoscopic (keyhole) anterior resection

Done through small cuts with a camera where suitable, often meaning less pain and a quicker recovery than open surgery. Sometimes performed with robotic assistance.

Open anterior resection

Through one larger cut, used when keyhole is not safe or suitable — for example with a bulky tumour, scarring or in an emergency.

With a temporary (defunctioning) stoma

A loop ileostomy is made higher up to divert stool away from the new join while it heals, then reversed by a smaller operation weeks or months later.

Anterior resection vs APR

Anterior resection	APR
Keeps the anus	Removes the anus
Bowel usually rejoined	Permanent colostomy
Stoma often temporary	Stoma is permanent
For higher rectal cancers	For very low rectal cancers
Bowel-control changes common	No back-passage function

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 one 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) and any other tests so the team knows exactly where the cancer is.
Meet the stoma nurse, have a stoma site marked and learn the basics — a temporary stoma is common with this operation.
Tell the team about all medicines, especially blood thinners, and about diabetes, heart or chest problems.
Stop smoking beforehand if you can, as it raises the risk of wound, chest and healing problems.
Follow the unit's enhanced-recovery and bowel-preparation advice and get as fit as you can beforehand.
Arrange time off work (often 6–8 weeks or more), a lift home and help at home for the first weeks.

What happens

The operation is done under general anaesthetic, so you are asleep, and usually takes about 3 to 5 hours. The surgeon frees the lower colon and rectum, removes the part containing the cancer along with the surrounding fatty tissue and lymph nodes, and then joins the colon to the remaining rectum or anal area with staples or stitches. This may be done by keyhole, robotic or open surgery.

Because the join sits low in the pelvis, many people have a temporary stoma (loop ileostomy) made to divert stool while the join heals. Sometimes a soft drain is left for a short time. If the anatomy is difficult, a keyhole operation may be switched to open surgery for safety.

Afterwards you recover on a ward, usually within an enhanced-recovery programme that helps you eat, drink and move sooner. 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 so low that the anus cannot be safely preserved, where an abdominoperineal resection (permanent stoma) may be advised instead.
You are not fit enough for a general anaesthetic and major surgery until other health problems are managed.
The MDT advises other treatment first, such as radiotherapy or chemotherapy, before any surgery.
Very poor baseline bowel control, where a low join may leave unacceptable function and a stoma might be preferable.

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 plan the right operation.
You have not yet met the stoma nurse or had a site marked when a stoma is likely.

Alternatives to discuss

A different operation such as abdominoperineal resection for very low cancers.
Radiotherapy and/or chemotherapy before surgery, which the MDT may advise to shrink the tumour.
Local removal of some very early cancers, where suitable, instead of major resection.
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 anterior resection 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 the rectal cancer with surrounding tissue and lymph nodes as part of treatment
Keeps the anus so the bowel can usually be rejoined and used normally
Most people avoid a permanent stoma, even if they need a temporary one
Keyhole or robotic surgery, where suitable, can mean less pain and a quicker recovery
Allows accurate staging of the cancer to guide any further treatment

Risks & complications

More common

Changes in bowel habit (low anterior resection syndrome) — frequency, urgency, clustering of motions or leakage — often for many months
Tiredness, pain and reduced appetite while you recover
A temporary stoma to care for, if one is made
Wound discomfort and a small risk of wound infection

Less common

Bleeding, sometimes needing a transfusion
Needing to convert from keyhole to open surgery
Bladder or sexual problems from nerves near the rectum (such as erection or ejaculation changes, or vaginal dryness)
Chest or urine infection after surgery
Blood clots in the legs or lungs

Rare but serious

Leak from the bowel join (anastomotic leak), which is serious and may need further surgery and a stoma
A collection of infection (abscess) in the pelvis needing drainage
Injury to nearby organs such as the ureter, bladder or small bowel
Needing a permanent stoma when a temporary one was planned
Serious problems related to the general anaesthetic, including very rarely a risk to life

The most serious specific risk is a leak from the bowel join (anastomotic leak), which is more likely with low joins and can make you very unwell, sometimes needing more surgery and a stoma. Bowel control can also change a lot afterwards (LARS). Ask your surgeon about your personal risk of a leak, your chance of a temporary or permanent stoma, and how nerve-related (bladder and sexual) function will be protected and discussed.

Published figures to discuss

Risk depends on how low the join is, whether the operation is planned or urgent, any radiotherapy beforehand, and your general health. The figures below are cautious ranges from surgical studies and audits, not guarantees for any one person. Low joins after rectal surgery carry a higher leak risk than higher joins.

Figure	Reported range	How to interpret it	Source / confidence
Anastomotic leak after anterior resection	Reported around 8–10% in large series and audits (about 9.7% for anterior rectal resection in one international audit)	Higher with low joins, radiotherapy and other risk factors. May need further surgery and a stoma. Source: ESCP CORREA 2022 audit and surgical literature.	Defunctioning ileostomy, time to closure and bowel function after low anterior resection — systematic review (PMC)pmc.ncbi.nlm.nih.govPublished figure
Death within 90 days of a leak needing reintervention	Higher than without a leak; one large study reported around 3.9% mortality with leakage versus 1.5% without	Risk rose mainly when a further operation was needed for the leak. Source: population-based cohort study (PMC6354192).	Defunctioning ileostomy, time to closure and bowel function after low anterior resection — systematic review (PMC)pmc.ncbi.nlm.nih.govPublished figure
Bowel-function change (low anterior resection syndrome)	Common, with major LARS reported in a substantial proportion, especially after low joins	Often improves over 6–12 months but may not fully resolve. Source: systematic review (PMC8187190) and NHS patient information.	Northern Care Alliance NHS — Low Anterior Resection Syndrome (LARS) patient informationnortherncarealliance.nhs.ukSource-linked context
Bladder or sexual dysfunction	Varies; reported in a notable minority because nerves run close to the rectum	Should be discussed beforehand and reviewed afterwards, with support available.	Defunctioning ileostomy, time to closure and bowel function after low anterior resection — systematic review (PMC)pmc.ncbi.nlm.nih.govSource-linked context

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

Anterior resection is major rectal surgery. Most people are in hospital for about a week and take 6–8 weeks or more to feel back to normal. Bowel function (low anterior resection syndrome) typically takes many months to settle and may not return fully to how it was.

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 at first and a stoma, if made, starts to work.

Days 3–7 (in hospital)

The bowel or stoma begins working and you build up eating and moving. Many people go home around the end of the first week once comfortable and managing any stoma.

Weeks 1–4 at home

Energy slowly returns. Walk little and often, avoid heavy lifting and build activity gradually. If you have a stoma, you get used to caring for it with the stoma nurse's help.

Weeks 6–12

Most people feel steadily stronger; lighter work is often possible. A temporary stoma may be reversed around now or later, after checks that the join has healed.

Beyond 3 months

Bowel function continues to change and settle, often over 6–12 months or longer (LARS). Cancer follow-up and any further treatment continue as planned.

What's normal — and not a worry

Frequent, urgent or clustered bowel motions after a stoma reversal that gradually improve (LARS)
Tiredness for several weeks that slowly lifts
A bloated tummy and reduced appetite in the early days
Soreness around the wounds and any stoma site
Getting used to stoma care if a temporary stoma was made

Aftercare

Take painkillers as advised and keep moving little and often to lower clot and chest-infection risk.
Build up activity gradually and avoid heavy lifting until your surgeon says it is safe.
If you have a stoma, use the stoma nurse's support and keep their contact details to hand.
Eat regular, balanced meals and follow any advice on managing loose or frequent motions.
Keep wounds clean and dry and follow advice on showering and dressings.
Do not drive until you can brake hard comfortably, are off strong painkillers and your insurer agrees.
Watch for warning signs such as severe pelvic or tummy pain, fever or a swollen tummy.
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
Help arranged at home for the first weeks
Loose, comfortable clothing and easy, balanced meals
Time off work booked (often 6–8 weeks or more)
Knowledge of warning signs (severe pain, fever, no wind or stool, leak symptoms)
The ward or clinic's contact number saved for problems

Scars and how they heal

Keyhole or robotic surgery leaves a few small scars plus a slightly larger cut where the bowel is removed. Open surgery leaves a longer scar down the middle of the tummy. If you have a stoma, there is also a small round site on the abdomen, which closes to a small scar after reversal. Scars are pink and firm at first and usually fade over months.

⚠ Get urgent help if…

Severe or worsening pelvic or tummy pain, or a hard, swollen, tender tummy
A high temperature, shivering or feeling very unwell (possible infection or leak)
Passing wind, fluid or stool from the back passage or wound when you have a protecting stoma (possible leak)
Spreading redness, heat, swelling or discharge from a wound
Heavy bleeding from the back passage, wound or stoma
A swollen, hot or painful calf, or breathlessness or chest pain (possible clot — call 999)
A stoma that stops working, turns dark/dusky, or pulls in or bulges suddenly

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 anterior resection is to remove the cancer completely with a clear margin and the nearby lymph nodes, while keeping the anus so the bowel can be used normally. 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. Bowel function afterwards is often different — low anterior resection syndrome (with frequency, urgency or leakage) is common, especially after low joins, and can take many months to settle. A good team is honest about both the cancer outlook and the likely effect on your bowel.

How long it lasts

Long-term outcome after rectal 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. Bowel function usually improves over the first year or so but may not return fully to how it was before, and some people have lasting changes that can be helped by diet advice, medicines, pelvic-floor exercises or specialist input.

Combining with other procedures

Anterior resection 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. A temporary stoma reversal is a separate, later operation. You should not feel pressured into unrelated add-on procedures.

Follow-up & long-term care

You will be reviewed after surgery to check healing and 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, plus a plan for future bowel checks. If you have a temporary stoma, the join is usually checked before reversal is arranged. You should always be told who to contact for problems, and bowel-function difficulties (LARS) should be actively asked about and supported.

Attend all follow-up appointments, scans and bowel checks after cancer surgery.
If you have a temporary stoma, follow the plan for checking the join and timing reversal.
Use diet advice, medicines, pelvic-floor exercises or specialist input to manage bowel-function changes (LARS).
Build back up to normal activity and lifting gradually over weeks.
Report any new bleeding, weight loss, tummy pain or change in symptoms promptly.
Stop smoking and keep to a healthy weight to support healing and general health.

Revision and secondary surgery reality

An anastomotic leak may need a further operation, drainage or a stoma.
A temporary stoma usually needs a second, smaller operation to reverse it, which carries its own risks and is not always possible.
If function after a low join is very poor, some people decide to have a permanent stoma later.
A hernia at a wound or old stoma site may need repair in the future.

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.
A named contact and out-of-hours number, with clear warning signs for leak, infection or blockage.
Explanation of the laboratory (pathology) results and the MDT plan and follow-up schedule.
Active support for bowel-function change (LARS): diet advice, medicines, pelvic-floor exercises or specialist input.
Stoma-nurse support and a clear plan for checking the join and reversing a temporary stoma.

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
Surgeon's and anaesthetist's fees
Theatre/facility time and length of hospital stay
Whether a temporary stoma is formed, plus stoma supplies and nursing support
Any radiotherapy or chemotherapy before or after surgery (separate treatment)
Pre-operative staging scans and explanation of laboratory (pathology) results
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 stoma formation, supplies and stoma-nurse support are covered, and any stoma-reversal operation
Pre-operative scans and explanation of laboratory (pathology) results
Follow-up appointments and cancer surveillance scans/colonoscopy
The cancellation policy
What happens, and who pays, if there is a complication such as a leak needing more surgery or a longer stay

On the NHS? Anterior resection is widely available on the NHS as part of rectal 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.

How low is my cancer, and can the anus be safely preserved with an anterior resection?
Will I need a temporary stoma, and when might it be reversed?
What is my personal risk of an anastomotic leak, and what would happen if it occurred?
How likely am I to have bowel-function changes (LARS), and what support is available?
How will my bladder and sexual function be protected and reviewed?
What further treatment and follow-up might I need after surgery?
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 need a stoma (bag)?

Often a temporary one. Many people having an anterior resection have a loop ileostomy made to protect the new join, which is usually reversed by a smaller operation weeks or months later. A minority need a longer-term or permanent stoma. Your surgeon will explain your likely situation.

What is low anterior resection syndrome (LARS)?

It is a common change in bowel habit after this operation, especially after low joins — including frequent or urgent motions, clustering of motions, or some leakage. It often improves over many months but may not fully resolve. Diet advice, medicines, pelvic-floor exercises and specialist support can help.

Can this be done on the NHS?

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

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.

How long is the recovery?

Most people are in hospital about a week and take 6–8 weeks or more to feel back to normal. Bowel function (LARS) typically takes many months to settle. Recovery is longer after open or emergency surgery or a physical job.

Find a verified surgeon for anterior resection (removing part of the rectum)

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 anterior resection (removing part of the rectum) →

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 Defunctioning ileostomy, time to closure and bowel function after low anterior resection — systematic review (PMC) Population-based study: mortality after anastomotic leak following anterior resection (PMC) ESCP CORREA 2022 audit — colorectal anastomotic leak benchmarks (Colorectal Disease) Northern Care Alliance NHS — Low Anterior Resection Syndrome (LARS) patient information

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.