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Level
Tumour extension
Operative plane
1: Levator origin to
top of puborectalis
Confined to muscle coat
LAR
Intersphincteric APE
Beyond muscle coat
LAR
Intersphincteric APE
Extending <1mm from
levator/mesorectal fascia
Extra-levator APE
Extending into/beyond levator
Extra-levator APE
2: Below puborectalis Extending into submucosa/
muscularis propria well defined
LAR
Intersphincteric APE
Extending full thickness of
muscularis propria
Extra-levator APE
Extending into intersphincteric
plane
Extra-levator APE
Extending into external sphincter Extra-levator APE
Beyond external sphincter into
schiorectal tissue
Pelvic exenteration
Shihab OC et al. Dis Colon Rectum 2011; 54(10):1260-4