What is anterior resection of the rectum?
Anterior resection of the rectum is an operation in which the affected segment of the rectum is removed together with the mesorectum, which contains lymph nodes, blood vessels, and fatty tissue. A colorectal or coloanal anastomosis is then created to restore bowel continuity.
The key step of the operation is *total mesorectal excision (TME)* — precise removal of the mesorectum within the embryological fascial planes, which is the international standard of treatment for rectal cancer.
Our approach
At MSI, rectal cancer is treated by a multidisciplinary team of colorectal surgeons, clinical oncologists, radiologists, endoscopists, and pathologists. Before surgery, the disease is fully staged, including colonoscopy, pelvic MRI, computed tomography, and other necessary tests.
We perform operations according to the principles of *Total Mesorectal Excision (TME)*, carefully following the fascial planes to ensure adequate circumferential and distal resection margins and a complete lymph node dissection.
Whenever possible, preference is given to the laparoscopic approach, which allows highly precise dissection in the narrow space of the pelvis, reduces surgical trauma, and speeds up recovery. Postoperative care follows the principles of *ERAS (Enhanced Recovery After Surgery)*.
When is surgery needed?
Anterior resection of the rectum is performed for:
- cancer of the upper rectum
- cancer of the middle rectum
- certain tumors of the lower rectum when the sphincter can be preserved
- large adenomas or precancerous lesions that cannot be removed endoscopically
- certain benign diseases of the rectum
Indications for surgery
Surgery is recommended for:
- localized rectal cancer
- locally advanced cancer after neoadjuvant therapy
- large precancerous lesions
- cases where radical endoscopic treatment is impossible
How is the operation performed?
The operation is performed under general anesthesia.
After the sigmoid colon and rectum are mobilized, a total mesorectal excision is performed according to TME principles. The affected segment of the bowel is removed together with the mesorectum and regional lymph nodes, and a colorectal or coloanal anastomosis is then created.
In patients with a low anastomosis, a temporary protective ileostomy may be created to reduce the risk of a clinically significant anastomotic leak.
Advantages of laparoscopic surgery
- Highly precise dissection in the pelvis
- Less surgical trauma
- Less postoperative pain
- Faster recovery of bowel function
- Lower risk of postoperative complications
- Better cosmetic result
- Oncological radicality in line with international standards
Recovery after surgery
Postoperative treatment follows the ERAS program. Early mobilization, modern pain relief, a gradual return to eating, and prevention of complications support a fast recovery.
Once the histopathology results are available, the further treatment and follow-up strategy is determined.
Our advantages
- Specialization in colorectal oncology
- Total mesorectal excision (TME) in line with international standards
- Maximum preservation of the sphincter when oncologically safe
- Preferential use of the laparoscopic approach
- Adherence to NCCN, ESMO, and ASCRS guidelines
- A multidisciplinary approach and an enhanced recovery program (ERAS)
Frequently Asked Questions
No. It depends on the location and extent of the tumor and on whether radical treatment can be performed while preserving the sphincter.
No. In many cases, bowel continuity is restored immediately. A temporary protective ileostomy is created only when indicated and is usually closed after a few months.
Total mesorectal excision is the international standard of surgical treatment for rectal cancer. It involves complete removal of the mesorectum together with the lymph nodes within the anatomical fascial planes.
For some patients, treatment begins with neoadjuvant chemoradiotherapy or total neoadjuvant therapy (TNT). The final strategy is determined by the multidisciplinary team according to the stage of the disease.
The goal of modern surgery is not only radical removal of the tumor but also the best possible preservation of bowel, urinary, and sexual function, while maintaining the principles of oncological safety.