关键词: 肛提肌外腹会阴联合切除术, 经会阴微创通路手术, 直肠癌, 并发症, 预后

Abstract: Significance and controversy of ELAPE for low-grade advanced rectal cancer        HAN Jia-gang,WANG Zhen-jun.Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University, Beijing 100020, China
Corresponding author：HAN Jia-gang，E-mail：hjg211@163.com
Abstract    Extralevator abdominoperineal excision（ELAPE） has been described as an important method for improving the outcome of advanced low rectal cancer，probably because of more pelvic dissection and less positive circumferential resection margin（CRM）under the guidance of precise anatomy.Laparoscopic or robotic assistance enables ELAPE with transabdominal levator transection with acceptable perioperative and pathological outcomes.Most studies suggest that ELAPE reduced the positive rate of CRM，the intraoperative perforation，and may further reduce the local recurrence rate and improve survival. However，ELAPE might result in a significantly increased rate of perineal wound complications，urinary and sexual dysfunction and chronic perineal pain.Trans-perineal minimally invasive approach and individual ELAPE technique have the potential to reduce the risk of chronic perineal pain and sexual dysfunction without influenced the radical effect.Biologic meshes using in perineal reconstruction significantly reduce the operative time，length of stay in hospital and the cost per patient.Although several studies show no benefit for ELAPE regarding oncological outcomes，ELAPE is still a milestone operation based on accurate surgery principle.

Key words: extralevator abdominoperineal excision, trans-perineal minimally invasive approach, rectal cancer, complication, prognosis