A pictorial description of extralevator abdominoperineal excision for low rectal cancer.
OBJECTIVE
Extralevator abdominoperineal excision in the prone position has been reported as a method to improve the poor outcome sometimes observed after abdominoperineal excision (APE) for low rectal cancer. In this paper a pictorial guide is presented describing the key anatomical steps and landmarks of the operation.


METHODS
Intraoperative footage of five APE operations filmed in high definition was reviewed and key stages of the operation were identified. Still frames were captured from these sequences to illustrate this guide. An edited video sequence was produced from one of these operations to accompany this paper.


CONCLUSIONS
The prone APE allows improved visualization of the perineal portion of the operation by the surgeon, assistants and observers. It permits clear demonstration for teaching. Prospective evaluation is still required to identify patients who would benefit from extralevator APE.
Colorectal Research, Pelican Cancer Foundation, Basingstoke, Hampshire, UK.
O C
OC
Shihab
R J
RJ
Heald
T
T
Holm
P D
PD
How
G
G
Brown
P
P
Quirke
B J
BJ
Moran
D000005:Abdomen / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D056888:Patient Positioning; D010502:Perineum / Q000601:surgery*; D016684:Prone Position; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D058106:Wound Closure Techniques