After long‑course chemoradiotherapy and abdominoperineal resection with a permanent colostomy, is there any remaining functional anal opening?

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No Functional Anal Opening After APR

After abdominoperineal resection (APR), there is no remaining anal opening—the entire anus, rectum, and surrounding tissue are surgically removed, and the perineal wound is closed permanently. 1

What Happens During APR

The surgical procedure involves complete removal of:

  • The entire rectum and anus, including the anal sphincter complex 1
  • Wide lateral perianal margins (often wider than required for rectal cancer alone) 1
  • Total mesorectal excision of all surrounding tissue 1

The perineal area where the anus was located is then closed, typically using reconstructive tissue flaps such as vertical rectus abdominis myocutaneous (VRAM) flap or local myocutaneous flaps. 1

Why Reconstructive Flaps Are Used

Because you received long-course chemoradiotherapy (LCCRT) before surgery, your surgical team should have used muscle flap reconstruction rather than simple primary closure. 1

The evidence strongly supports this approach:

  • Radiation exposure causes poor perineal wound healing in patients undergoing APR 1
  • Rectus abdominis myocutaneous flap reconstruction significantly decreases perineal wound complications compared to primary closure after radiation 1
  • Studies show wound complications occur in 16-39% of APR patients overall, with higher rates after radiation 2, 3
  • LCCRT specifically increases overall wound complications (58% vs 30% without treatment), making flap closure even more critical 4

What You Have Now

Your anatomy consists of:

  • A permanent colostomy on your abdominal wall for bowel elimination 1
  • A closed perineal wound where your anus used to be, ideally reinforced with muscle flap tissue 1
  • No anal canal or opening—this structure no longer exists 1

Common Wound Healing Issues to Monitor

Given your history of LCCRT followed by APR, watch for these perineal wound complications:

  • Delayed wound healing (most common after radiation) 2, 4, 5
  • Wound infection or abscess formation 2, 3
  • Wound dehiscence (separation >2 cm requires reoperation in 5-14% of cases) 2, 3
  • Persistent sinus tracts or non-healing wounds (can persist beyond 1 year in 11% of patients) 5
  • Perineal hernias (late complication) 2

Risk factors that increase your complication risk include: obesity (BMI >30), diabetes, comorbid conditions, and the radiation itself. 2, 3, 4, 5

Follow-Up Surveillance

You should undergo evaluation every 3-6 months for 5 years, including:

  • Digital examination of the perineal wound site (not rectal exam—there is no rectum) 1
  • Inguinal lymph node palpation 1
  • Annual chest, abdominal, and pelvic CT with contrast for 3 years (given your stage II-III disease requiring LCCRT) 1

The 5-year survival rate after APR for anal carcinoma ranges from 39-66%, with worse prognosis associated with node-positive disease at initial presentation and radiation doses <55 Gy. 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma.

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2007

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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