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The anatomic considerations for extralevator abdominoperineal excision (ELAPE) are shown. (A-B) Blue arrows demonstrate a “waist” in the ELAPE specimen versus (C-D) a specimen with no “waist” (orange arrows). (D) A locally advanced rectal cancer specimen (patient underwent chemoradiotherapy) with an intact mesorectum (white arrow) and an acceptable ELAPE with no waist (orange arrow). (B) Adapted with permission.9
