Extralevator Abdominoperineal Excision for Rectal Cancer: “Extended” is the Only Correct Route

Abstract

Abdominoperineal excision (APE) of the rectum is being performed since more than one hundred years, following the technical description of the procedure reported on Lancet by Sir Ernest Miles. APE can be perfomed either medially to the levator ani (intersphincteric APE) or removing it by sectioning the muscle at its pelvic attachment (extralevator APE, ELAPE). However, some publications recently introduced the concept that the procedure can be classified “standard” or “extended” (“extralevator”). This concept should be carefully examined to avoid confusion.