title: [Anatomical key points and operative principle of "two planes and four landmarks" in extralevator abdominoperineal excision].
abstract: Abominoperineal resection (APR) is the main approach of lower rectal cancer treatment. Recently, it was found that conventional APR had higher incidence rate of positive circumferential resection margin(CRM) and intraoperative perforation (IOP), which was the crucial reason of local recurrence and worse prognosis. Extralevator abdominoperineal excision(ELAPE) procedure was proposed by European panels including surgeons, radiologist and pathologists, and considered to lower the positive rates of CRM and IOP. Definitive surgical planes and anatomic landmarks are the cores of this procedure, which are the prerequisite for the guarantee of safety and smoothness of surgery. To realize the anatomy of muscles, fascias, blood vessels and nervous of perineal region is the base of carrying out ELAPE procedure. In this paper, we introduce the key anatomy related to ELAPE procedure and summarize the principle of ELAPE procedure as "two planes and four landmarks", which will be beneficial to the popularization and application.
authors.affiliation: Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China. yeyingjiang@pkuph.edu.cn.
authors.forename: Yingjiang
authors.initials: Y
authors.lastname: Ye
authors.forename: Zhanlong
authors.initials: Z
authors.lastname: Shen
authors.forename: Shan
authors.initials: S
authors.lastname: Wang
mesh_terms: D000005:Abdomen / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D006801:Humans; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery