[Three types of abdominoperineal excision procedures for the rectal cancer based on anatomic landmarks classification].

Abdominoperineal excision (APE) procedure is still the main approach to low rectal cancer patients with short distance from the anal verge, obvious invasion of adjacent organs and narrow pelvis. Although the principle of TME (total mesorectal excision) needs to be obeyed in the abdominal phase of APE procedure, it does not reach the consensus for the perineal phase. The important reason is the lack of definite anatomic landmarks in the perineal phase, thus the standardization of the procedure remains hard. In 2014, Swedish surgeon, professor Holm, proposed the new conception to classify the APE procedure into three types, which were intersphincteric APE, the extralavator APE and the ischioanal APE, based on the anatomic landmarks with perineal fascias, nervous and blood vessels. In this paper, we combine the review of literatures and our experiences of treatment to introduce and discuss these three types of APE procedures. This new concept is based on anatomic landmarks which makes the category of APE procedure more definitive, the anatomic dissection more clear and the standardization and adoption of APE procedure much easier.