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Last updated: 14-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Cancer Surgeon (GI)
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
★★★★★ Google: 4.9 from 53 reviews (Gota clinic) · 5.0 from 25 reviews (Apollo, Bhat)
Dr Harsh Shah performs keyhole, robotic and open rectal cancer surgery. Every very low rectal cancer is discussed at the tumour board before any operation is planned.
In short
Intersphincteric resection removes a very low rectal cancer with the inner ring of anal muscle. The outer ring stays, so you keep a working anus.
The upper part of the operation can be done by keyhole surgery. In expert hands its cancer results match open surgery. The lowest part is done from below.
A robot may help when the pelvis is very narrow and the tumour is bulky after radiation. It does not change who can safely keep the muscle.
The anus has two rings of muscle. The operation removes the rectum and the inner ring, and keeps the outer ring that you squeeze with.
The inner ring is a thickening of the bowel wall itself. The outer ring is a separate muscle you control. Between them lies a thin natural plane. The surgeon works in that plane, so the cancer comes out with a clear edge below it. The end of the colon is then stitched to the anal canal by hand. This is the alternative to removing the anus and living with a permanent colostomy.
| How much of the inner ring is removed | When it is chosen |
|---|---|
| Part of it. | The lower edge of the cancer is a little higher up. |
| Most of it. | The cancer reaches lower, near the line where the anal skin begins. |
| All of it. | The cancer reaches lowest. The join is made almost at the opening of the anus. |
Three things decide it: how close the cancer is to the muscle ring, whether the outer muscle is free of cancer, and how good your bowel control is now.
| Usually suited | Usually not suited |
|---|---|
| The lower edge of the cancer is just above the muscle ring. | The cancer is even closer, or reaches into the anal canal. |
| MRI and examination show the outer muscle is clear. | The outer muscle or the pelvic floor is involved. |
| Bowel control is good before treatment. | Control is already poor. A permanent colostomy may give a better life. |
| You and your family understand the change in bowel habit. | Regular exercises and visits afterwards are not possible for you. |
| The cancer has shrunk well after treatment given first. | The edge of the fat around the rectum is threatened on MRI. |
Most of these cancers get chemotherapy and radiotherapy first. The decision to operate is made at the tumour board after a repeat MRI. If the cancer has disappeared, watch-and-wait may be offered instead.
All three remove the same tissue and make the same join. They differ only in how the surgeon reaches the deep pelvis from above.
| Approach | What our technique note says | Where it fits |
|---|---|---|
| Keyhole. | In large studies, keyhole ISR gave the same cancer results as open ISR. | Most patients who are suited to ISR. |
| Robotic. | Wristed tools and a steady 3D view may help at the bottom of the pelvis. | A very narrow male pelvis with a bulky tumour after radiation. |
| Open. | The same operation through a longer cut. | When keyhole access is not safe for you. |
The robot is not used for the part done from below. That part is done by hand through the anus in every approach. A robotic operation also costs more, and insurance cover differs. Your surgeon explains which approach suits your pelvis and your scans.
The operation works from two directions. From above, the rectum is freed by keyhole surgery. From below, the inner muscle is cut and the two planes meet.
The temporary ileostomy rests the new join while it heals. It is usually closed about two to three months later, after a test shows the join is sound.
| When | What usually happens |
|---|---|
| Before surgery. | The stoma nurse marks the site and teaches the basics. |
| The first week. | You learn to empty and change the bag. Home in about five to ten days. |
| About six weeks. | A scan with contrast checks the join. |
| About eight to twelve weeks. | A short second operation closes the ileostomy. |
Bowel habit changes for most people after this operation. Going often, urgency and some leakage are common at first, and usually ease over one to two years.
Doctors call this low anterior resection syndrome. It is worst in the first months after the ileostomy is closed. The more of the inner ring is removed, the more marked it tends to be. Some people adapt well. For others, symptoms last for years. A small number later choose a permanent colostomy for a calmer life. This is why the trade-off is explained before consent, with your family present.
For a very low cancer there are three paths. The right one depends on the MRI, the response to treatment, your bowel control and your own priorities.
| Path | What it means | Who it suits |
|---|---|---|
| Intersphincteric resection. | The anus is kept. Bowel habit changes. | Outer muscle clear, good control, ready for rehabilitation. |
| Abdominoperineal resection. | The anus is removed. A permanent colostomy. | Outer muscle involved, cancer too low, or poor control. |
| Watch-and-wait. | No operation while the cancer stays gone. Close checks. | The cancer has disappeared after treatment, and you accept frequent checks. |
Yes, in selected patients. The outer muscle must be free of cancer and bowel control must be good.
Not for everyone. It may help in a very narrow pelvis with a bulky tumour after radiation.
A temporary ileostomy, always. It is usually closed after two to three months.
Usually not at first. Frequency and urgency are common, and ease over time with exercises and support.
Then the anus cannot be safely kept. The operation removes it and makes a permanent colostomy.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of MRI and pathology reports, second opinions, follow-up.
Google: 4.9 · 53 reviews
Apollo Hospital, Bhat, Gandhinagar
Admission, keyhole, robotic and open surgery, and inpatient care.
Google: 5.0 · 25 reviews
Told your rectal cancer is very low, and wondering if the anal muscle can be kept? Your MRI of the pelvis, colonoscopy and biopsy reports can be sent ahead on WhatsApp, so the visit starts with them already read. Whether this operation suits you is decided at the visit, after examination, and by the tumour board. Call +91-63590-11009 · WhatsApp your reports
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