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Low Anterior Resection (LAR) is the standard sphincter-saving surgery for cancers of the middle and lower rectum. The rectum containing the tumour is removed along with its mesorectal envelope (Total Mesorectal Excision — TME), and the colon is joined to the anal canal or remaining rectum. The patient retains normal bowel control and avoids a permanent colostomy.
TME — the surgical gold standard for rectal cancer — involves sharp dissection in the embryological plane to remove the rectum with its complete mesorectal envelope intact. This technique reduces local recurrence rates from 25-30% (without TME) to below 5% and has transformed rectal cancer outcomes. Dr. Ashok Kumar was trained in TME during his tenure at SGPGI, Lucknow.
A defunctioning loop ileostomy is routinely created after LAR to protect the anastomosis (bowel join) while it heals. This is a temporary measure — the ileostomy is reversed after 6–10 weeks once healing is confirmed by contrast enema. Most patients are stoma-free within 3 months of LAR.
For T3/T4 or node-positive rectal cancers, chemoradiation (CRT) is given 6–8 weeks before surgery. This shrinks the tumour, improves the chance of clear margins, increases sphincter preservation rates and reduces local recurrence. Dr. Ashok Kumar works with the oncology team at Charak Hospital to coordinate multimodal rectal cancer treatment.