Low anterior resection (LAR) and abdominoperineal resection (APR) are two surgical procedures for managing rectal cancer, each with unique benefits and considerations. Both procedures involve removing cancerous parts of the rectum.

Rectal cancer is a significant health concern worldwide. Surgical intervention is a crucial component in the treatment of rectal cancer.

This article explores the differences between these two procedures, their similarities, and their respective aftercare. We also explore alternative surgical approaches and the outlook for patients undergoing these surgeries.

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Miquel Llonch/Stocksy

Low anterior resection (LAR) and abdominoperineal resection (APR) are surgical procedures used to treat rectal cancer. They typically involve removing part or all of the rectum. However, they differ in their approach and outcomes for those undergoing the procedures.

A doctor may only carry out APR if other treatments, such as radiation therapy and chemotherapy, do not work or if the cancer comes back after treatment.

Learn more about LAR surgery.

Similarities between LAR and APR include:

  • Cancer removal: Both procedures aim to remove cancerous tissue from the rectum, reducing the risk of cancer spreading to other parts of the body.
  • Colostomy: In some cases, both procedures may involve creating a surgically created opening in the abdominal wall that diverts feces into a colostomy bag. However, the location of the colostomy differs between the two surgeries.

The choice between LAR and APR depends primarily on the tumor’s location in the rectum and the ability to preserve the anal sphincter. LAR is the preferable surgical option when the tumor is located in the upper part of the rectum.

A surgeon will typically perform APR when the tumor is very low in the rectum or near the anus. APR may also treat anal cancer.

These differences have a significant impact on postoperative bowel function and the need for a temporary or permanent stoma.

The procedure for LAR typically involves the following steps:

  1. Anesthesia administration: A patient receives general anesthesia.
  2. Abdominal incisions: The surgeon makes multiple small incisions in the abdominal area, creating access points for the surgical instruments.
  3. Cancer and tissue removal: The surgeon removes the cancerous tissue, including a margin of healthy tissue surrounding the cancer.
  4. Colon reattachment: The colon reconnects to the remaining rectum. This reconnection may help avoid the need for a permanent colostomy.
  5. Short-term ileostomy: In some instances, patients who have received radiation and chemotherapy before the surgery may receive short-term ileostomy. The purpose of the ileostomy is to allow the rectum to heal before stool can pass through it again.
  6. Hospital stay: Following the LAR, patients may spend several days in the hospital. The duration of the stay varies depending on the specific details of the surgery and the patient’s overall health.
  7. Recovery at home: Patients can expect a recovery period of approximately 3 to 6 weeks at home; however, this may vary depending on the person’s overall condition.

The procedure for APR typically involves the following steps:

  1. Anesthesia administration: A patient receives general anesthesia.
  2. Incisions for access: The surgeon makes multiple small incisions in the abdominal area and skin surrounding the anus, creating access points for the surgical instruments.
  3. Cancer and tissue removal: The surgeon proceeds to remove the rectum, the anus, and the surrounding tissues, including the sphincter muscle. This extensive removal is necessary due to the proximity of the cancer to the anus.
  4. Permanent colostomy: With the complete removal of the anus makes a permanent colostomy obligatory. In this process, a surgeon connects the end of the colon to an opening created in the abdominal skin. This allows stool to pass out of the body through the colostomy, effectively bypassing the rectum.
  5. Hospital stay: Following the APR, patients may spend several days in the hospital. The duration of the hospital stay varies depending on the specific details of the surgery and the patient’s overall health.
  6. Recovery at home: Patients can expect a recovery period of approximately 3 to 6 weeks. However, this may vary depending on the patient’s overall condition.

In addition to LAR and APR, several other surgical procedures can aid rectal cancer treatment, depending on the stage and location of the tumor, including:

  1. Polypectomy: Polypectomy involves a wire loop through the colonoscope to cut the polyp from the wall of the rectum with an electric current.
  2. Local excision: This is a minimally invasive procedure for very early stage rectal cancers. It involves the removal of the tumor and a small amount of surrounding tissue through the rectum using a colonoscope.
  3. Transanal excision (TAE): A surgeon removes the cancer and some adjacent healthy rectal tissue by cutting through the layers of the rectal wall. Afterward, the opening in the rectal wall closes. Surgeons do not remove lymph nodes during TAE.
  4. Transanal endoscopic microsurgery (TEM): TEM is a procedure for larger, more advanced tumors situated in the upper part of the rectum. It allows for a minimally invasive removal of the tumor.

After LAR and APR procedures, patients go through a recovery process that includes various aspects of aftercare, including:

  • Rectal healing: After surgery, wound healing may take several months.
  • Colostomy care: Patients with a colostomy require guidance on how to care for their stoma and colostomy bag.
  • Dietary changes: Initially, patients may need to follow a special diet to ease the transition back to regular eating.
  • Physical activity: Gradual physical activity can help regain strength and prevent complications.
  • Follow-up appointments: Regular check-ups and surveillance are crucial to monitor the patient’s recovery and potential cancer recurrence.
  • Supportive care: Emotional and psychological support and access to support groups can be valuable in the recovery process.

The choice between LAR and APR primarily depends on the tumor’s location and the person’s overall health. LAR is the preferred choice when preserving anal sphincter function is possible, as it allows for a better quality of life. However, when APR is necessary, it can still provide effective cancer treatment, but likely with permanent changes to bowel habits.

Patients should be aware that both procedures have potential risks and side effects, which can include infection, bleeding, and bowel dysfunction. The creation of a colostomy may also lead to emotional and psychological challenges, although many individuals may adapt well over time.

Regular follow-up with healthcare professionals and following recommended lifestyle changes can significantly contribute to a person having a positive outlook on their recovery journey.

Low anterior resection (LAR) and abdominoperineal resection (APR) are surgical procedures for treating rectal cancer, each with a unique approach and implications.

LAR aims to preserve anal sphincter function and is preferable for upper rectal tumors. APR involves the removal of the entire rectum and is used when sphincter preservation is not possible due to the tumor’s location.

Both procedures may involve creating a colostomy, although the colostomy’s location differs.

Aftercare and support are essential for people undergoing these surgeries. Ultimately, the choice between LAR and APR is a complex decision best made by a medical team in consultation with the patient.