Published online Jun 14, 2020. doi: 10.3748/wjg.v26.i22.3012
Peer-review started: December 31, 2019
First decision: February 19, 2020
Revised: March 27, 2020
Accepted: May 26, 2020
Article in press: May 26, 2020
Published online: June 14, 2020
Since its introduction, extralevator abdominoperineal excision (ELAPE) in the prone position has gained significant attention and recognition as an important surgical procedure for the treatment of advanced low rectal cancer. Most studies suggest that because of adequate resection and precise anatomy, ELAPE could decrease the rate of positive circumferential resection margins, intraoperative perforation, and may further decrease local recurrence rate and improve survival. Some studies show that extensive resection of pelvic floor tissue may increase the incidence of wound complications and urogenital dysfunction. Laparoscopic/robotic ELAPE and trans-perineal minimally invasive approach allow patients to be operated in the lithotomy position, which has advantages of excellent operative view, precise dissection and reduced postoperative complications. Pelvic floor reconstruction with biological mesh could significantly reduce wound complications and the duration of hospitalization. The proposal of individualized ELAPE could further reduce the occurrence of postoperative urogenital dysfunction and chronic perianal pain. The ELAPE procedure emphasizes precise anatomy and conforms to the principle of radical resection of tumors, which is a milestone operation for the treatment of advanced low rectal cancer.
Core tips: Since extralevator abdominoperineal excision procedure (ELAPE) was proposed, the surgical approach and technique have been gradually developed, and recognized by an increasing number of colorectal surgeons. This is a first review to report in detail the research progress and controversies of ELAPE in the last decade including advantages of procedure, incidence of postoperative complications, controversies about operative position, development of laparoscopic/robotic technologies and proposal of individualized treatment /trans-perineal approach.