What is Abdominoperineal Resection (APR)?

APR is a major surgery for cancers of the lower rectum and anal canal where the tumour directly invades the anal sphincter muscles, making sphincter-saving surgery oncologically unsafe. The operation removes the rectum, anal canal, and sphincter muscles through two incisions — one abdominal and one perineal — resulting in a permanent end colostomy.

When is APR Necessary?

• Low rectal cancer within 1 cm of the sphincter where negative margins cannot be achieved with sphincter preservation
• Cancer directly invading the external sphincter or levator ani muscles
• Pre-existing poor sphincter function where functional outcome of sphincter-saving surgery would be unacceptable
• Anal canal squamous cell carcinoma not responding to chemoradiation (salvage APR)

Life After APR — Permanent Colostomy

A permanent end colostomy (sigmoid colostomy) is created in the left lower abdomen. Modern stoma appliances are discreet, odour-proof and allow a full, active lifestyle. Charak Hospital provides dedicated stoma care nursing support to help patients adjust confidently. Most patients resume all normal activities including travel, exercise and work within 6–8 weeks.