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Patrick Maguire, MD, Oncology, answeredTumors that are located at least a couple of inches above the anal sphincter are usually able to be removed (quite often after preoperative concurrent chemoradiotherapy or chemoRT) without need for a colostomy. The colorectal surgeon will perform a type of surgery called a total mesorectal excision, which involves removal of the rectal tumor with surrounding tissue and nearby lymph nodes all together in one sharply dissected specimen. The colon is joined to the anus, as long as the tumor can be removed with negative surgical margins, while leaving the anal sphincter muscle functioning. When tumors arise in the very low rectum, sometimes surgery requires creation of a colostomy. The bottom portion of the rectum and the anus are removed in this procedure, called an abdominoperineal resection. Most major cancer centers have support groups for patients who require a colostomy.