This page provides information about a surgical procedure to remove the structures at the end of the large bowel (colon) as part of treatment for cancer. We hope that this answers some of the questions you might have but please ask if there is any information you need or if you have any further questions.
Your surgeon has recommended that you have an abdominoperineal excision of rectum (APER for short). This operation involves the removal of the structures which form the back passage (rectum, the anus and the muscles that control your bowel movements). It may also involve the removal of part of the sigmoid colon (the part of the colon which is connected to the rectum).
This surgery can be done using keyhole (laparoscopic) surgery techniques or by making a large cut in the abdomen (open surgery). The type of surgery you have will depend on your medical history and any treatment you have already had. Your surgeon will discuss the details of your operation with you.
As your back passage is being removed, you will have a wound on your bottom area (perineum) as well as on your abdomen after the operation.
During the operation you may need to have a flap of tissue moved from another area to cover the hole where your rectum was. The type of flap you have will depend on your anatomy and any previous surgery you have had. Your surgeon will discuss the type of flap they plan to use before your operation.
After the surgery you will no longer be able to sit on the toilet to open your bowels. You will need a permanent stoma (colostomy). A stoma is when part of your bowel is brought out of the body through an opening on the wall of the abdomen. Waste matter from your body passes into a stoma bag which is worn over the stoma. The pictures below show the structures which will be removed and how the colostomy will look. Having a stoma is likely to be worrying for you. The stoma care nurses will offer you support and practical help on how to manage it.
The aim of the surgery is to remove the cancer completely if this is possible. For most patients this will provide a cure. This may be combined with chemotherapy and radiotherapy to help treat the cancer completely. If you do not have the procedure it is likely that your condition will get worse.
Your surgery will be done by a surgeon with specialist skills and training in bowel surgery, usually a Consultant Surgeon or a Specialist Registrar. It is likely that more than one surgeon will perform the surgery. If you need a flap as part of your surgery a Plastic Surgeon will also be present at the time of the operation.
For most conditions the only alternative to an APER is treatment with medication. However, drug treatment and / or radiotherapy may not cure the disease. Sometimes, it may be possible to remove a rectal cancer without the need for major surgery but this type of surgery only helps a small number of patients.
This type of surgery is a major operation and there are risks. However, the risks of the operation are quite small and much less than doing nothing.
The risks of all types of surgery include:
- wound infection
- chest infection
- heart problems (such as abnormal heart rhythm or rarely a heart attack)
- blood clots (in the legs or rarely the lungs). Most patients are given medication to thin the blood and stockings to wear in hospital to help prevent a blood clot.
The specific risks of APER include:
- breakdown of the perineal wound (the wound on your bottom) or the wound on your abdomen an ileus (temporary paralysis of the bowel)
- a temporary blockage of the bowel
- bleeding
- damage to other organs in the abdomen.
There is a small chance that any of these complications may require further surgery.
Sometimes the disease may have spread further than first thought. This may mean a different kind of surgery may be needed and it may be necessary to remove more of the large bowel or part of a nearby organ such as the small bowel, bladder or an ovary in women.
In men there is a risk of impotence (failure to achieve an erection) or retrograde ejaculation (semen going into the bladder rather than out of the penis). These risks are higher if you have radiotherapy as well as surgery.
There is a risk of death in about one in every thousand operations. The risks of serious complications are higher for elderly or overweight patients or those with other health conditions such as heart problems, chest problems, diabetes or kidney disease.
There are also risks from the general anaesthetic which we will discuss with you before the surgery.
You will have an appointment in the pre-assessment clinic before your admission where we will assess your fitness for surgery. You will have blood tests and an electrocardiogram (a test which looks at your heart rhythm) and you may also have other tests such as an exercise tolerance test. Most patients will see a nurse at their pre-assessment appointment but some will see an anaesthetist.
You will also speak to the Enhanced Recovery Nurse who will give you information about your surgery and recovery. There is a page called ‘Information for patients undergoing bowel surgery’ which provides more information about the Enhanced Recovery programme.
You will meet one of the stoma nurses who will give you information about the stoma and mark the stoma site on you abdomen.
You may be asked to take medication the day before your surgery to empty your bowel. If this is needed we will give you the medication and information about how to take it.
Most patients are admitted to hospital on the morning of the operation. You will stay in hospital for around seven to ten days but this may be longer. It is likely that you will wait several hours before you are taken to the operating theatre.
By law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Staff will explain all the risks, benefits and alternatives before they ask you to sign the form. If you are unsure about any aspect of the procedure, please speak with a senior member of staff again.
There are two parts to the operation. After you have been put to sleep the surgeon will make a cut in the wall of your abdomen. This may involve several small cuts for keyhole surgery or one large cut for open surgery. The rectum and the tissues around it, including the blood vessels and lymph glands, will be cut away from the surrounding tissues.
After this the surgeon will make a cut around the anus to separate these structures from the surrounding tissues. Then the rectum and anus will be removed, along with the cancer. The space which has been created will then be filled with a flap if this is needed.
The colostomy site is prepared and the end of the large bowel which has been left behind will be brought to the abdominal wall to create the colostomy. The wounds will then be stitched or clipped. The stitches are usually made with thread which dissolves by itself but if clips are used these will need to be removed around ten days after the surgery. Most patients have the clips removed at their GP surgery after they go home.
After the operation you will wake up with a cannula in the back of your hand to give you fluid and medication. You will also have a urinary catheter to help you pass urine.
You may also have an epidural to help your pain, a surgical drain in your abdomen and if you have a stoma, a clear bag over the stoma site.
You will only be allowed sips of water for the first few hours after surgery. You should not be in pain but may feel bruised and uncomfortable. Please tell the nurses looking after you if you are in pain so that they can try to help you manage this.
Physiotherapy staff will see you every day and help you to move about both in and out of bed. You will be given exercises for your breathing and moving your legs which help to reduce the risk of blood clots and a chest infection.
The stoma nurses will see you and show you how to care for it. If a friend of family member wishes to be involved so that they can support you with this, we will try to arrange this. When you first pass stool it will be liquid. It may take several weeks, or even months, to get used to the new way you pass stool. Some people need to change what they eat to keep their bowel movements regular. Please be patient with yourself and ask if you are worried or would like more information.
Recovery from the operation can take up to twelve weeks or more. The recovery period can be longer if you need chemotherapy or radiotherapy.
The page called ‘Information for patients undergoing bowel surgery’ gives information about your recovery and returning to day to day activities.
You will be given an appointment or a telephone consultation to discuss the results of the operation with a surgeon or a Clinical Nurse Specialist. You will be given information about the next stage of your treatment or, if you do not require further treatment, you will begin the follow-up programme.
At the first follow-up programme appointment we will give you an end of treatment summary explaining how the programme works and when you will have tests. The time of tests depends on the outcome of your surgery. Some patients will also have CT scans if these are needed. Most patients are discharged from the programme after five years but will be offered colonoscopy (a camera test of the large bowel) at regular intervals.
UCH Macmillan Support and Information Service
Address: UCH Macmillan Cancer Centre, Huntley Street, London, WC1E 6AG
Direct line: 020 3447 3816
Switchboard: 08451 555 000 / 020 3456 7890 ext. 73816
E-mail: uclh.
You can also find video information about your surgery by visiting our page Having surgery at UCLH.
There are a number of other organisations which provide information and support to patients and carers:
Macmillan Cancer Support
Telephone: 0808 808 0000 (Monday to Friday, 09:00-20:00)
Beating Bowel Cancer
Telephone: 0845 970 1301
E-mail: nurse
Colostomy Association
Telephone: 0800 3287 4257
E-mail: cass
Ileostomy Association
Telephone: 0800 018 4724
E-mail: info
UCLH cannot accept responsibility for information provided by other organisations.
If you have any concerns after you go home, such as bleeding or abdominal pain, please contact the Clinical Nurse Specialists. If you have an urgent problem which cannot wait please go to your local Emergency Department.
Clinical Nurse Specialist (Monday to Friday 09:00-17:00)
Direct line: 020 3447 9188
Switchboard: 0845 155 5000 / 020 3456 7890 ext. 79188
E-mail: uclh.
Stoma Nurses (Monday to Friday 09:00-17:00)
Direct line: 020 3447 9182
Switchboard: 0845 155 5000 / 020 3456 7890 ext. 79182
E-mail: uclh.
On-call Surgical Registrar (out of hours emergencies only)
Switchboard: 0845 155 5000 / 020 3456 7890
Enhanced Recovery Nurse (Monday to Friday 08:00-17:00)
Mobile: 07852 905980
Switchboard: 0845 155 5000 / 020 3456 7890
Address: Colorectal Surgery Department, Ground Floor West, 250 Euston Road, London, NW1 2PG
Services
Page last updated: 09 April 2025
Review due: 01 April 2027