New surgical conception of management for low rectal cancer: extralevator abdominoperineal excision        YE Ying-jiang, WANG Shan. Department of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044，China
Corresponding author: WANG Shan, E-mail: shwang60@sina.com
Abstract    The widespread adoption of the abdominoperineal excision (APE) and total mesotectal excision for rectal cancer has led to significant improvements in oncologic outcomes. However, the rate of circumferential resection margin (CRM) involvement and the incidence of intraoperative perforation (IOP) of APE for lower rectal cancer are still higher than those of anterior resection (AR) for higher rectal cancer. Extralevator abdominoperineal excision (ELAPE) for low rectal cancer has been introduced to decrease CRM and IOP and improve local radicality. ELAPE is recognized as a new concept for management of lower rectal cancer in Europe. ELAPE should be performed on the extralevator plane based on the principles of TME. Understanding anatomic landmark and operation principles can shorten the learning curve of surgery.