Abdominoperineal Resection (APR Surgery)

What is an abdominoperineal resection?

An abdominoperineal resection (APR) is a type of surgery that your surgeon may do to treat rectal cancer. In an APR, your surgeon may remove your anus (butthole), rectum and part of your colon. They’ll also do a permanent colostomy.

How should I prepare for an abdominoperineal resection?

An APR is a major surgery. There’s a lot that goes into getting ready for it. Your care team will let you know if you need tests or other appointments before your surgery. Tests may include blood tests and imaging tests, like CT scans or MRI scans.

You may have other appointments to meet with your anesthesia team and other healthcare providers. They’ll help make sure you’re ready for surgery. You may meet with other surgeons who may participate in your surgery.

You’ll also meet your ostomy nurse. They’ll explain what an ostomy is and how to care for it. They’ll discuss places on your belly where an ostomy may go and pick the spot that’s best for it.

Your care team will explain what you need to do to get ready for surgery. For example, they’ll:

• Ask if you smoke, and if you do, they’ll ask you to try to stop smoking several weeks before your surgery
• Recommend you avoid drinking beverages that contain alcohol
• Ask you about the medications you take regularly, including over-the-counter medications and herbal supplements
• Ask if you have obstructive sleep apnea (OSA)

Having OSA increases your risk of anesthesia complications. If you use a CPAP device, they’ll ask you to bring it with you the day of your surgery.

They’ll tell you to start a clear liquid diet the day before your surgery and do bowel prep the morning of your surgery.

What happens during an abdominoperineal resection?

You’ll receive general anesthesia so you’re asleep during surgery. The surgery involves several steps. Your surgeon will:

1. Make incisions in your belly (small incisions if laparoscopic or robotic surgery, otherwise a single large incision)
2. Remove part of your colon, your rectum and your anus — these organs share blood vessels, which is why your surgeon will remove all of them at the same time
3. Remove all lymph nodes that go to your rectum
4. Close the skin below your rectum, which means you won’t have an opening there
5. Do a permanent colostomy at the spot chosen before surgery

Your surgery will take several hours.

What are the potential complications of an abdominoperineal resection?

An APR is major surgery with significant potential risks, including death. The risks of the operation can include:

• Bleeding
• Blood clots in your legs that can travel to your lungs
• Damage to nearby tissues
• Pneumonia
• Infection
• Heart attack
• Stroke

You may need more surgery to manage complications. You may also have long-term complications, including an infection in your pelvis. You may develop a hernia around the ostomy or in the area where your anus and rectum were located. This is a perineal hernia.

What happens after an abdominoperineal resection?

You’ll remain in the hospital for several days after your surgery. You’ll have a catheter to drain pee from your bladder. Your care team will remove the catheter after a few days so you can pee on your own. You’ll also have a drainage tube in your belly that your care team will eventually remove. Your team will give you pain medications.

You’ll be able to drink fluids after your surgery. You’ll be able to eat soft foods the day after your surgery. You’ll also be able to get out of bed and walk.

You’ll have one-on-one teaching sessions with your ostomy nurses. They’ll explain how to care for your new ostomy. They’ll also give you the supplies you’ll need to take care of it.

You’ll be able to go home once you:

• Can eat soft foods
• Poop
• Manage pain with medication that you can take at home
• Feel comfortable caring for your ostomy

You may have a home health nurse who will come to your home to help you with your ostomy.

Your team will understand that you’re receiving a lot of information soon after surgery. You may want to ask a family member or friend to sit in on these information sessions. Don’t hesitate to ask questions or ask your team to repeat any of the steps they’ve shown you.

What is the recovery time?

It takes time to recover from abdominoperineal resection. You’ll continue to eat soft food for several weeks. If you work, it may be a few weeks before you can return. But your return to work depends on how well your surgical wounds heal and the type of work that you do.

You’ll have to avoid some activities during your recovery, including:

• Soaking in water, like taking a bath, using a hot tub or swimming — but you’ll be able to shower
• Lifting heavy objects for six to eight weeks after your surgery, which reduces the chance you’ll develop a hernia
• Driving, at least until you stop taking narcotic pain medications

You should make sure you feel confident that you can drive safely. This includes being able to quickly hit the brakes.

When should I call my healthcare provider?

Contact your surgeon if you have the following issues:

• Severe belly pain even after you take pain medication
• Fever of 101.5 degrees Fahrenheit (38.6 degrees Celsius) or higher
• Nausea and vomiting
• Constipation or diarrhea
• Redness, swelling or pain at the incision sites
• Difficulty with your ostomy