Carpelan A, et al. - The results of abdominoperineal excisions (APE) for locally advanced rectal cancer were comprehensively examined by the researchers before and after the adoption of extralevator abdominoperineal excision (ELAPE) with a special reference to long-term survival. A non-significant tendency to lower rates of intraoperative perforation (IOP) and positive circumferential resection margin (CRM) along with a lower rate of local recurrence (LR) was disclosed in the ELAPE group. No variation was reported between the groups in the long-term survival and adverse events. Data revealed that ELAPE was beneficial for the surgeon in offering better vicinity to the perineal area and better work ergonomics. The use of ELAPE technique was supported by the technical aspects and the clinically pivotal tendency to lower rate of LR, regardless of the lack of survival benefit.