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Rectal Resection – Procedure, Techniques & Recovery

Rectal resection is a surgical procedure in which part or all of the rectum is removed. It is most commonly performed for rectal cancer, inflammatory bowel disease, or severe functional disorders of the rectum.

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Things worth knowing about "Rectal Resection"

Rectal resection is a surgical procedure in which part or all of the rectum is removed. It is most commonly performed for rectal cancer, inflammatory bowel disease, or severe functional disorders of the rectum.

What is a Rectal Resection?

Rectal resection is the surgical removal of part or all of the rectum, which is the final section of the large intestine before the anus, measuring approximately 15 to 18 centimetres in length. The rectum plays a key role in stool storage and controlled bowel evacuation. Rectal resection is a major procedure in abdominal surgery and may involve partial or complete removal of the rectum depending on the extent of disease.

Indications

Rectal resection is recommended for a range of conditions, including:

Rectal cancer: Malignant tumour of the rectum – the most common indication
Inflammatory bowel disease: Crohn's disease or ulcerative colitis with severe rectal involvement
Rectal prolapse: Protrusion of the rectum through the anus
Rectal polyps: Large or endoscopically unresectable polyps
Diverticular disease: Severe complications involving the rectal region
Rectal injuries: Severe trauma or perforation of the rectum

Surgical Techniques

Several surgical techniques are available for rectal resection, selected based on the location and extent of the condition:

Anterior Resection

Anterior resection involves removal of the diseased segment of the rectum through an abdominal incision or minimally invasively (laparoscopically). The remaining bowel is then reconnected to the anal canal or residual rectal stump (anastomosis). In many cases, this approach preserves the sphincter muscle and thus natural continence.

Low Anterior Resection

For tumours located in the lower rectum, a low anterior resection is performed with creation of a deep anastomosis close to the pelvic floor. A temporary protective stoma (artificial bowel opening) may be created to allow the anastomosis to heal, after which the stoma is reversed.

Abdominoperineal Resection

When a tumour is located very low in the rectum and involves the sphincter muscle, an abdominoperineal resection (APR) is necessary. This procedure involves complete removal of the rectum and sphincter complex, requiring a permanent colostomy (artificial bowel opening).

Total Mesorectal Excision (TME)

Total mesorectal excision (TME) is the gold standard in surgical treatment of rectal cancer. The rectum is removed along with its surrounding fatty and lymphatic tissue envelope (the mesorectum) in a single intact unit, maximising the chance of complete tumour removal and reducing the risk of local recurrence.

Minimally Invasive Approaches

Many rectal resections are now performed laparoscopically (keyhole surgery) or using robotic-assisted techniques. Compared to open surgery, these approaches offer advantages such as smaller incisions, reduced postoperative pain, shorter hospital stays, and faster recovery.

Preparation and Follow-Up Care

Before surgery, thorough diagnostic workup is performed, including colonoscopy, MRI, and CT scanning, as well as bowel preparation. For rectal cancer, neoadjuvant chemoradiotherapy (radiation therapy combined with chemotherapy before surgery) is frequently used to reduce tumour size and lower the risk of recurrence.

After surgery, regular follow-up examinations, pelvic floor physiotherapy, and dietary counselling are important components of recovery. Patients with a stoma receive intensive nursing support from specialist stoma care therapists.

Possible Complications

As with any major surgical procedure, complications may occur:

Anastomotic leak (failure of the bowel connection to heal properly)
Postoperative bleeding
Wound infections
Injury to adjacent organs (bladder, ureters, pelvic nerves)
Bladder and sexual dysfunction due to pelvic nerve injury
Bowel function changes such as frequent urgency or incontinence (Low Anterior Resection Syndrome, LARS)

Quality of Life After Surgery

Many patients experience changes in bowel habits following rectal resection, such as increased frequency or temporary incontinence. With targeted rehabilitation, pelvic floor training, and if necessary medication support, quality of life can be significantly improved for most patients over time.

References

German Cancer Society (Deutsche Krebsgesellschaft): S3 Guideline Colorectal Cancer, Version 2.1 (2019), AWMF Registration No. 021/007OL.
Soreide K et al. - Rectal cancer. The Lancet, 2024; 403(10430): 927-941. DOI: 10.1016/S0140-6736(23)02052-0.
Heald RJ - The Holy Plane of rectal surgery. Journal of the Royal Society of Medicine, 1988; 81(9): 503-508.

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