Extralevator abdominoperineal excision for advanced low rectal cancer: Where to go

Figure 1 Individualized extralevator abdominoperineal excision procedure. A: Tumor not involving the ischioanal fat or levator ani muscle (T3), leave 1 cm of the levator ani muscles on the pelvic sidewall; B: Tumor located at one side (T3), levator ani muscle on the other side may be left; C: Tumor penetrating the levator ani muscle (T4) bilaterally, dissection should include the fat of the ischioanal fossa and the intact levator ani muscle bilaterally; D: Tumor penetrating the levator ani muscle (T4) unilaterally, part of the ischioanal fat and intact lavator ani muscle should be dissected unilaterally. This Figure is reprinted with authors’permission[13,60].