When it is recommended
For cancers in the lower third of the rectum, where a very careful approach is needed to remove the tumour while preserving the anal sphincter and continence.
Pre-operative chemoradiation is sometimes given to shrink the tumour first and improve the chances of sphincter preservation. It is a technically demanding operation.
How the operation is performed
The same TME principles as a standard anterior resection, with extra care taken in the lower pelvis. The colon is joined very low to the anal canal using a circular stapler (colo-anal anastomosis). The operation is technically demanding and benefits from a high-volume surgeon.
Temporary stoma
Almost always performed with a temporary protective ileostomy, reversed once healing is confirmed (typically 8–12 weeks later).
Recovery and function
Hospital stay 6–8 days. Bowel function after low anterior resection changes: many patients experience “low anterior resection syndrome” (frequent, urgent or clustered bowel movements) in the first 6–12 months, which usually improves substantially with time, diet and pelvic floor therapy.