APR surgery for rectal cancer? Don't be afraid, let's talk about the details (Abdominoperineal Resection)

Has your doctor told you or someone you know needs surgery for rectal cancer? It's normal to feel nervous and anxious at a time like this. Especially when you know it's a major surgery like an 'APR'. But don't worry. Being well -informed about these types of surgeries can greatly reduce your fear. Today, we'll talk about what an APR is, how to prepare for it, and what to expect after the surgery.

Simply put, what is this APR surgery?

Abdominoperineal Resection, also known as APR, is a major surgery performed primarily to treat cancers of the lower rectum. It is a somewhat complex surgery.

Think about it, the last part of our digestive system is the anus and rectum. Depending on where the cancer is, to completely remove the cancer cells, the surrounding area may also need to be removed. To be precise, during this APR procedure, your surgeon will do a few key things:

• Your anus , the opening through which feces exit, is completely removed and the area is sewn up.
• Your rectum , the last part of your large intestine, is removed.
• Part of your colon will also be removed.

Now you may be wondering, "How will I defecate then?" Yes, that's the biggest difference in this surgery. Because the anus is removed, a new path for stool to exit the body needs to be created. That's why a permanent colostomy is done.

Simply put, the remaining part of your colon is taken and the end of it is connected to the surface of the skin of your abdomen. This opening is called a 'stoma' . Then, a special bag (ostomy bag) is attached to this stoma. Your stool then goes directly into this bag. This may be a new thing at first, but you will get used to it over time. There are special nursing staff to help you with this.

How do we prepare before surgery?

Since APR is a major surgery, it is very important to prepare for it. Your medical team will explain everything to you. Below are some of the things that can happen during this preparation.

What happens during the surgery?

Because you are under general anesthesia, you will not feel anything during the surgery. You will be sound asleep. The surgeon's team will perform this surgery over several hours.

This surgery can usually be done in two ways:

1. Open Surgery: The traditional method is performed through a single long incision in the abdomen.

2. Laparoscopic/Robotic Surgery: This method is performed through a few small incisions in the abdomen, using a camera and special instruments. This method has a shorter recovery time and is less painful.

During surgery, the surgeon removes the rectum, anus, and part of the colon where the cancer is located. At the same time, the lymph nodes around the area are also removed. This is because these lymph nodes are where cancer cells can spread. Then, as discussed earlier, the stoma is created in the abdomen and the skin where the anus used to be is sewn up and closed.

What are the possible complications after surgery?

Since APR is a major surgery, like any major surgery, there are some risks involved. But don't worry, the medical team is doing their best to minimize these risks. It's important to be aware of the possible complications.

• Bleeding: Bleeding may occur from the surgical site.
• Infection: Infections can occur in cuts or inside the body.
• Blood clots: Blood clots can form in the legs and travel to the lungs. To prevent this, you are advised to walk quickly after surgery.
• Damage to surrounding organs: There is a small chance of damage to organs around the surgical area, such as the bladder.
• Anesthesia-related problems: The risk of serious complications such as pneumonia, heart attack, and stroke is very low, but it's good to be aware of them.

Sometimes, there are long-term complications that occur over time. For example, a hernia can develop around the stoma. There is also a possibility of a perineal hernia where the anus has been removed.

What happens in the hospital after surgery?

After the surgery, you will need to stay in the hospital for a few days. During this time, the medical team will take good care of your recovery.

• Tubes and tubes: A catheter will be placed to drain your urine. A drain will also be placed in your abdomen to drain any fluid that collects at the surgery site. These will be removed in a few days.
• Painkillers:You will be given medication as needed to control the pain.
• Food: After surgery, you will be given fluids to drink first. You can start eating soft foods like soup and yogurt the next day.
• Walking: Getting out of bed as soon as possible and walking around is very important for the healing process. It can help prevent things like blood clots.
• Ostomy training: This is the most important training you will receive in the hospital. The ostomy nurse will come and teach you how to care for your new stoma, change the pouch, and keep your skin clean. Don't be afraid to ask again and again until you understand. Ask a family member to join you at this time. That way, you will have someone to help you when you go home.

You will be allowed to go home when you are able to eat soft foods, control the pain with home remedies, and feel confident enough to care for your ostomy on your own.

How is the recovery time after going home?

It will take some time to fully recover after you return home. During this time, listen to your body. If you are tired, rest.

If you are employed, it may take a few weeks or a month to return to work, depending on how your injuries heal and the nature of your work.

When to call the doctor

If you have any problems during your recovery, call your doctor or the hospital where you had your surgery right away. Be sure to report any of the following symptoms:

• Severe stomach pain that cannot be controlled even with painkillers.
• Fever. A fever of 38.6 degrees Celsius (101.5 Fahrenheit) or higher.
• If vomiting and nausea persist.
• Constipation or diarrhea.
• If the incision areas are red, swollen, or painful .
• If you have any discomfort or problems with your ostomy .

APR surgery is a life-changing experience. It will take time to get used to it. Talk to your doctor, family, and friends about your concerns, fears, and feelings. You don't have to go through this journey alone.