Anal cancer is usually treated with chemotherapy and radiation therapy. You may need surgery if these treatments aren’t effective or if you have a small tumor.

Surgery may involve removing your tumor and a small amount of healthy tissue around it. It can also involve removing your:

  • entire anus
  • rectum
  • part of your large intestines

Here, we cover everything you need to know about surgery for treating anal cancer.

Surgical options for anal cancer include local resection and abdominoperineal resection (APR).

Local resection

Local excision, or local resection, involves cutting the tumor from your anus along with some healthy tissue around it to make sure no cancer cells remain. You may receive this procedure if your cancer is small and hasn’t spread to other tissues.

Local resection may preserve your sphincter muscles so you can retain bowel control.

Abdominoperineal resection

Abdominoperineal resection involves removing your:

  • lower colon
  • rectum
  • anus

Your doctor will connect the end of your small intestines to a hole in your abdomen called a stoma that allows waste to be collected in a colostomy bag. You may also have lymph nodes removed during the operation.

APR is generally only used for cancer that comes back or doesn’t respond to radiation therapy and chemotherapy. A small number of people receive it as their first treatment.

APR can be performed using one of several techniques.

Open surgery

Open surgery involves removing your tissues through a large incision. It’s the most invasive surgical option.

Laparoscopic (keyhole) surgery

Laparoscopic surgery involves removing your tissue through smaller incisions with a long, thin tube. It’s less invasive and associated with a lower chance of infection.

Robotic-assisted surgery

Robotic-assisted surgery was first performed in the early 2000s. It allows surgeons to perform precision movements with the help of a three-dimensional camera.

Most people with anal cancer will mainly have chemotherapy and radiation therapy. Surgery may be necessary:

In a 2023 study using data from 47 hospitals, researchers reported the following 5-year overall survival rates:

Treatment type5-year survival
Salvage APR for reoccurrence75%
Salvage APR for persistent cancer36%
Non-salvage APR for reoccurrence42%
Non-salvage APR for persistent cancer47%

Salvage therapy means the surgery is performed as the last attempt to cure the cancer after previous treatment failed.

Potential risks of anal cancer surgery include:

Here’s an idea of what to expect before, during, and after your procedure.

Before the procedure

You’ll receive tests before your procedure to measure your overall fitness. They may include:

During the procedure

Here’s a general idea of what will happen during your procedure.

Local resection

You will usually receive general anesthesia to put you to sleep before your procedure. Your surgeon will remove your tumor with a scalpel. They’ll also remove enough healthy tissue so there’s no evidence of cancer along the edges of the removed section.

Open APR

You’ll receive general anesthesia to put you to sleep before your procedure.

Your surgeon will make a large incision around your anus. They will then sever the main blood vessels that supply your lower bowel. Your anus, rectum, and lower large intestines will be removed, and your skin will be sewn shut.

You’ll then receive a colostomy where the end of your large intestines is brought to a hole in your abdomen.

Laparoscopic APR

The procedure for a laparoscopic APR is similar. Instead of performing the procedure through a large incision, your surgeon will use a series of small incisions and a thin tube called a laparoscope.

Robotic APR

Robotic APR is similar to laparoscopic APR, but the procedure involves the use of a camera that allows your surgeon to perform extremely fine movements.

After the procedure

You’ll likely need to stay in the hospital for at least a few nights. If you receive an APR, you might need to stay for 7–10 days.

You’ll need to stop eating at least 6 hours and drinking 2 hours before your procedure if you receive general anesthesia. Doctors often strongly recommend quitting smoking before surgery to improve your recovery. Additionally, for any anal surgery, you’ll need a bowel prep similar to that before a colonoscopy. This involves a liquid diet and taking a solution orally to empty the bowel.

It can take 3–6 weeks to recover from APR. It’s important to avoid squatting for 3 weeks.

In a 2018 study, researchers estimated the average cost of the first 2 years of anal cancer treatment to be $127,531. Medicare and other insurance programs generally cover most of the treatment costs when deemed medically necessary.

Other treatments for anal cancer include:

Here are some frequently asked questions people have about anal cancer.

How fast does anal cancer grow?

In a 2020 study, researchers estimated that anal cancer doubled in size every 211 days in a group of 43 people.

Can you die from anal cancer?

Anal cancer is usually curable unless it’s spread to distant tissues. In the United States from 2012–2018, people with anal cancer that had spread to distant areas lived at least 5 years about 36% as often as people without anal cancer.

Is anal cancer curable?

Anal cancer is often curable when it’s contained in your anus or nearby tissue. People with cancer contained to their anus lived at least 5 years 83% as often as people without anal cancer in the United States from 2012–2018.

What is the anal cancer survival rate?

In the United States from 2012–2018, the 5-year relative survival rate of anal cancer was 70%.

Learn more about the outlook of anal cancer.

How long does it take to recover from anal cancer surgery?

You will likely need to stay in the hospital for at least a few days and up to 10 days.

Chemotherapy and radiation therapy are the most common treatments for anal cancer. Surgery may be used for small cancers or cancers that don’t respond to other treatments.

Anal cancer surgery can be lifesaving for people who need it. Your medical team can advise you if you may benefit from surgery and what the potential complications may be.