![]() Even after 110 years, this technique remains the standard choice for low rectal cancers (mainly found up to 5 cm from the anal verge) according to the ESMO guidelines for rectal cancer. Back in 1908, Ernest Miles first described the abdomino-perineal excision (APE). The treatment of cancer of the rectal lower third has been a challenging issue over time. This is the first case of the open HLE that seems to be a good alternative compared to ELAPE or conventional APR, as it offers oncologic adequacy and a fair anorectal function. Anorectal manometry revealed a fair anorectal function which is in accordance with the findings of clinical assessment of patient after restoring large bowel continuity (post-op Wexner score, 7). MRI at the fourth postoperative week showed clearly the right aspect of anorectal junction free of tumor. Pathology proved the oncologic adequacy of resection. ![]() At the contralateral side of the tumor, the dissection plane follows the classic route of LAR. ![]() The proposed operation consists of a combination of extralevator abdomino-perineal excision (ELAPE), intersphicteric resection (ISR), and low anterior resection (LAR) since it resects the ipsilateral to tumor levator ani muscle (LAM) from its attachment at the internal obturator fascia and the deep part of ipsilateral external anal sphincter (EAS), while the distal part of dissection is completed in the intersphincteric space taking out the internal anal sphincter (IAS). MethodsĪ 60-year-old male patient with a high-grade differentiated rectal adenocarcinoma at the right side of the lower rectum invading puborectalis muscle. This study aims to present the feasibility of the open approach of hemilevator excision (HLE) as a promising alternative of the laparoscopic and/or robotic ones for the treatment of low rectal cancer extending to the ipsilateral puborectalis muscle. ![]()
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