Rectal Cancer Surgery in Ankara, Turkey

Rectal cancer surgery involves the surgical removal of the tumor-bearing segment. Surgery performed at an early stage helps prevent the disease from spreading and improves survival. The treatment plan is determined through a multidisciplinary approach, considering the tumor’s location, size, and stage.

Low anterior resection is used to remove tumors located in the lower part of the rectum. With this method, bowel continuity can be preserved, allowing normal bowel function to continue. Patient suitability is assessed through detailed examinations.

Abdominoperineal resection is preferred for tumors very close to the anus. In such cases, a permanent colostomy may be required. During treatment planning, the goal is to balance oncologic safety and quality of life. The decision-making process should be discussed in detail together with the patient.

Chemotherapy or radiotherapy may be administered after rectal cancer surgery. These adjuvant treatments reduce the risk of recurrence and improve long-term survival. After surgery, regular follow-up and imaging are essential to keep the disease under control.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Rectal Cancer Surgery in Ankara, to get information about Rectal Cancer Surgery prices, the process, and the hospital where Rectal Cancer Surgery is performed.

What Is Rectal Cancer?

Rectal cancer is a malignant tumor disease that develops in the rectum, the final segment of the large intestine. It is a subtype of colorectal cancer and often arises from polyps. It may not cause symptoms in early stages, but later it can lead to changes in bowel habits, bleeding, and abdominal pain. Diagnosis is made by colonoscopy, and treatment may include surgery, chemotherapy, and/or radiotherapy.

What Is Rectal Cancer Surgery?

Rectal cancer surgery should not be thought of as simply cutting out a tumor. This operation is a highly delicate anatomical journey performed with the precision of an artwork. The fundamental principle of modern rectal cancer surgery is called “Total Mesorectal Excision” (TME). Although this sounds technical, the concept is straightforward. The rectum is not an isolated organ; it is surrounded by a rich fatty tissue package called the “mesorectum,” which contains blood vessels, lymphatic channels, and lymph nodes where cancer can first spread. This package is enclosed by a thin protective fascial layer.

The essence of TME is to remove this entire package in one piece without damaging the protective layer. During surgery, the surgeon advances through a natural, relatively bloodless plane between this fascia and the pelvic walls, often described as the “holy plane.” Compared to older, more blind dissection methods, this approach helps ensure no cancerous tissue is left behind while also protecting nearby vital organs and nerves.

The core goals of this meticulous approach are:

• Complete oncologic clearance: Removing the cancerous tissue together with potential pathways of spread as one intact specimen without tearing the fascial envelope. A smooth, intact mesorectal surface is a hallmark of surgical quality.
• Safe surgical margins: Achieving tumor-free margins—especially laterally—which is a key factor in reducing local recurrence.
• Preservation of function: Carefully protecting the nerve network that controls urinary and sexual function to maintain quality of life as much as possible.

In short, rectal cancer surgery is a comprehensive treatment that fights cancer while also safeguarding the patient’s future function and quality of life, requiring significant precision and experience.

When Is Rectal Cancer Surgery Performed?

The decision for rectal cancer surgery is the central part of a personalized treatment plan. It is made jointly by a multidisciplinary team (tumor board), considering the disease status and the patient’s overall health. The timing, surgical strategy, and whether additional preoperative treatment is needed are evaluated carefully.

The most critical step that shapes the surgical plan is accurate staging. One of the most valuable tools is high-resolution pelvic MRI. MRI serves as a roadmap for the surgeon and provides essential preoperative information such as:

• How deeply the tumor invades the rectal wall
• Whether nearby lymph nodes are involved
• The tumor’s distance to the planned surgical boundary (mesorectal fascia)
• How close the cancer is to the anal sphincter muscles

In addition, colonoscopy is indispensable both to confirm the diagnosis and to obtain a tissue sample (biopsy). In very early-stage tumors, endorectal ultrasound (EUS) may also provide detailed information.

Based on these findings, if the tumor is classified as “locally advanced”—for example, large size, lymph node involvement, or proximity to critical surgical margins—surgery is often not performed immediately. In such cases, neoadjuvant therapy (preoperative chemotherapy and radiotherapy) is typically recommended.

The key aims of neoadjuvant therapy include:

• Shrinking the tumor to make surgery safer and easier
• Increasing the chance of complete removal with clean margins
• Reducing the need for permanent stoma by enabling sphincter preservation in very low tumors
• Minimizing the likelihood of local recurrence after surgery

A more recent approach is the “watch-and-wait” strategy. In carefully selected patients who show an exceptional response to neoadjuvant therapy—meaning no detectable tumor remains on follow-up evaluations—close surveillance may be considered instead of immediate surgery. This option can spare the patient from major surgery but requires very strict and disciplined follow-up.

What Are the Risks of Rectal Cancer Surgery?

As with any major surgery, rectal cancer surgery has potential risks and complications. Although modern surgical techniques, anesthesia, and postoperative care protocols have significantly reduced these risks, it is important for patients and families to be aware of them so that problems can be recognized early and treated promptly.

The most common and most important risk is an anastomotic leak. After the cancerous bowel segment is removed, the remaining healthy ends are reconnected. This connection is called an “anastomosis.” If the suture line does not heal properly and bowel contents leak into the abdominal cavity, an anastomotic leak can occur. This may lead to serious intra-abdominal infection (abscess, peritonitis, sepsis) and can be life-threatening. It may require urgent reoperation. Treatment depends on severity and can range from antibiotics and drainage to creating a temporary stoma to protect the anastomosis.

Another important area involves stoma-related issues. Especially in low rectal surgery, a temporary ileostomy may be created to protect the anastomosis. While this can be a lifesaving measure, it may cause challenges such as dehydration and electrolyte loss affecting kidney function, skin irritation around the stoma, parastomal hernia, or stoma retraction/prolapse. In addition, closing a temporary stoma requires a second operation with its own risks.

Because the rectum lies close to nerves that control urinary and sexual function, these functions can also be affected. Despite careful nerve-preserving techniques, particularly in large tumors or patients who have received radiotherapy, these nerves may be impacted. In men, erectile or ejaculation problems; in women, pain or dryness during intercourse; and in both sexes, difficulty urinating or urinary incontinence may occur.

Other general surgical risks include:

• Infections at the wound site, lungs, or urinary tract
• Bleeding during or after surgery
• Blood clots in the legs (deep vein thrombosis)
• Clots traveling to the lungs (pulmonary embolism)
• Temporary cessation of bowel movements after surgery (ileus)

How Is Rectal Cancer Surgery Performed?

Rectal cancer surgery is not a single standardized method. The technique is carefully chosen based on the tumor’s location within the rectum, its size, the patient’s general condition, and the surgeon’s expertise. While the guiding principle remains Total Mesorectal Excision (TME), different approaches may be used to achieve this goal.

Based on how the surgery is performed, the main approaches include:

• Open surgery: The traditional method performed through a larger abdominal incision.
• Laparoscopic surgery (minimally invasive): Performed through several small incisions using a camera and specialized instruments. It often offers less pain and faster recovery.
• Robotic surgery: The most advanced form of minimally invasive surgery. The surgeon controls robotic arms from a console, benefiting from 3D magnified, stable imaging and highly precise instruments—especially advantageous in the narrow, deep pelvis. This can support more delicate dissection and nerve preservation.

The type of resection also depends on tumor location:

• Low Anterior Resection (LAR): A sphincter-preserving surgery for tumors in the upper and mid rectum. The cancerous segment is removed, and the colon is reconnected to the remaining rectum or directly to the anus. Normal defecation can continue. A temporary ileostomy may be created to protect the anastomosis.
• Abdominoperineal Resection (APR): Used for very low tumors that involve or lie too close to the anal sphincter muscles to preserve them. The rectum, anus, and sphincter muscles are removed, so bowel continuity cannot be restored and a permanent colostomy is required.
• Local excision (e.g., TAMIS): Suitable only for very early-stage, small, superficial cancers. No abdominal incisions are made; the tumor is removed through the anus using a specialized platform, sparing the patient from major surgery.
• Transanal TME (TaTME): An innovative technique for very low tumors or technically challenging cases such as obesity. Surgery is performed with two teams working simultaneously—one from the abdomen (laparoscopic/robotic) and one transanally. This “bottom-up” approach provides excellent visualization in the deep pelvis and may improve surgical precision in selected cases.

Recovery After Rectal Cancer Surgery

The postoperative period is no longer a time when patients simply lie in bed and wait to heal. Thanks to modern, evidence-based approaches known as ERAS (Enhanced Recovery After Surgery) protocols, patients are now active participants in recovery. ERAS aims to reduce surgical stress, prevent complications, and help patients return to normal life as quickly as possible.

Recovery often begins days before surgery:

• Providing detailed information to the patient and family
• Optimizing nutritional status
• Allowing clear carbohydrate-rich fluids up to 2 hours before surgery
• Avoiding overly aggressive bowel preparations when not necessary

During and immediately after surgery, key steps support comfort and safety:

• Effective multimodal pain control (not relying only on narcotics)
• Careful fluid balance management
• Strong anti-nausea medications to prevent vomiting
• Maintaining normal body temperature

During the hospital stay, essential ERAS measures include:

• Early mobilization: Patients are encouraged to stand and walk—often even on the evening of surgery—with nursing support, reducing clot and lung complication risks.
• Early feeding: Oral intake is initiated within the first 24 hours when appropriate, supporting faster return of bowel function.
• Avoiding unnecessary tubes and drains: Urinary catheters, surgical drains, and nasogastric tubes are not routinely used and are removed as early as possible if needed.
• Active participation: Breathing exercises, gentle movement, and involvement in self-care improve recovery.

With these protocols, many patients can be discharged within about 3 to 7 days, feeling safe and able to perform basic daily activities.

What to Pay Attention to After Rectal Cancer Surgery

Being discharged from the hospital is not the end of the journey—it is a new beginning. To achieve full recovery and stay healthy long-term, patients should make certain adjustments and pay attention to key areas.

The importance of regular follow-up:

Postoperative check-ups are essential for detecting recurrence or new problems as early as possible. A typical surveillance plan may include:

• Scheduled clinic visits
• CEA (tumor marker) blood tests
• Imaging such as chest and abdominal CT scans
• Periodic surveillance colonoscopies

Managing bowel habits:

After sphincter-preserving surgery (such as LAR), bowel function changes are very common. This is called Low Anterior Resection Syndrome (LARS), which may include:

• Frequent bowel movements
• Urgency
• A feeling of incomplete emptying
• Gas or stool leakage

Although this often improves over time, it can affect quality of life. Dietary adjustments, pelvic floor exercises (Kegels), and sometimes medications can help manage symptoms.

Diet:

Nutrition is an important part of healing. A balanced, healthy diet is the foundation. For patients with a stoma or those experiencing LARS, practical tips may include:

• Drinking plenty of fluids—especially water
• Avoiding gas-forming foods (legumes, cabbage, cauliflower, etc.) for a period
• Limiting very fatty and spicy foods that may worsen diarrhea
• Gradually increasing fiber intake in a controlled way
• Eating smaller, more frequent meals

Stoma care:

For patients living with a stoma, daily care becomes part of routine life. With proper education from a stoma care nurse, this is usually learned quickly. Using the right pouching system, changing it regularly, and keeping the skin around the stoma clean and dry are essential for protecting skin health.

Physical and emotional recovery:

As physical recovery progresses, starting gentle exercise with your doctor’s approval can rebuild strength and improve mood. A cancer diagnosis and major surgery can also be emotionally demanding. Feeling anxiety, sadness, or worry about the future is normal. Talking with family and friends, joining support groups, or seeking professional psychological support can make this journey easier. You are not alone.