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
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.