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Types of surgery

Find out about the different types of surgery for anal cancer.

When do you have surgery

You usually have a combination of chemotherapy and radiotherapy (chemoradiotherapy) as your main treatment for anal cancer.

You might have surgery:

  • if chemoradiotherapy doesn't get rid of the cancer completely - you may hear this called salvage treatment
  • to remove the cancer, if you have a very early cancer of the anal margin

The type of operation you have depends on:  

  • where your cancer is
  • the type and size of your cancer
  • whether your cancer has spread

Before your operation, your doctor will talk to you about the best type of surgery for your situation.

Removing the tumour

If you have a very early cancer of the anal margin, your surgeon will remove the affected area. This is called a local resection. They will leave the anal sphincter (muscle) intact so you can still control your bowel after the surgery.

Your surgeon will send the cancer tissue to the laboratory. A specialist doctor (pathologist) examines it under a microscope. They check that the border of tissue around the tumour is free of cancer cells. This is called a clear margin.

You need a general anaesthetic for this operation and usually stay in hospital for a few days.

Removing the anus, rectum and part of the large bowel

This operation is called an abdomino perineal resection (APR). You might have this surgery if your cancer has come back or if it hasn’t gone completely after chemoradiotherapy.

Your surgeon removes your: 

  • anus
  • rectum
  • part of your colon

They might also remove: 

  • some of the lymph nodes near your anus
  • the lymph nodes in your groin

As part of this surgery, you will need to have a colostomy. This is when the surgeon makes an opening in the skin of your tummy and stitches the end of your bowel to the opening. The opening is called a stoma. You wear a bag over the stoma to collect your poo (faeces).

Diagram showing abdominoperineal resection of the anus

To remove cancer of the anus, you might have keyhole or robotic surgery.

Keyhole surgery

You might have part of this operation as keyhole (laparoscopic) surgery. Your surgeon makes several small cuts in your abdomen (tummy). This is instead of one large cut that you'd have with open surgery.

Your surgeon passes a long, narrow, bendy tube  called a laparoscope through one of the cuts. The laparoscope connects to a camera that shows pictures of the inside of the body on a video screen. The surgeon then passes other instruments through the other cuts and watches what they are doing on the screen. 

You might have one slightly larger cut in your tummy, where your surgeon carries out some of the surgery and takes out the tumour. With both open and laparoscopic surgery you will also have a wound around the anus, in the perineum.

Keyhole surgery seems to be as good as traditional open surgery at getting rid of the cancer. But the operation can take longer. People who have keyhole surgery may have less pain and get back to normal more quickly. You might also leave hospital sooner. Your surgeon will discuss the risks and benefits of both types of surgery with you.

Robotic surgery

Some surgeons may use a robotic machine to do part of the keyhole operation. The surgeon controls the machine using a specialised unit. The robotic machine gives the surgeon a better view of the inside of your tummy, and allows surgeons to make finer movements.

Robotic surgery is still a new technique and not all hospitals in the UK have this. Doctors hope that robotic surgery will cause less damage to nerves and give fewer side effects. 

Information and help

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