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AIM: To evaluate the safety and efficacy of tumor-specific extralevator abdominoperineal excision (TS-ELAPE) for low rectal cancer.METHODS: This study involved a retrospective evaluation of a prospective surgical database.Fifty-six patients who underwent TS-ELAPE from June 2011 to June 2015 were evaluated in Beijing Chaoyang Hospital, Capital Medical Universtiy.TS-ELAPE technique was as follows.In those T3 rectal tumors, the dissection plane may continue close to the outside of the external anal sphincter and the inferior aspect of the levator ani muscles,leaving 1 cm of the levator ani muscles on the pelvic sidewall to keep the terminal branches of the pudendal nerve intact;If the tumor locates at only one side of the rectal wall (T3), the levator ani muscle on the other side of the tumor might be left;In those T4 rectal tumors bilaterally, the dissection should include the fat of the ischioanal fossa and the intact levator ani muscle bilaterally to achieve a clear circumferential resection margins;In those T4 rectal tumors unilaterally, part of the ischioanal fat and intact lavator ani muscle should be dissected unilaterally and the muscle on the opposite side partially preserved.The main outcome measures were circumferential resection margin involvement, intraoperative perforation,postoperative complications, and local recurrence.RESULTS: During the study, fifty patients (89.3%) received preoperative chemoradiotherapy.Fifty-one patients (91.1%) had the sacrococcyx preserved, 27 (48.2%) patients with the levator ani muscle partially preserved bilaterally, 20 patients (35.7%) with the levator ani muscle partially preserved unilaterally and the muscle on the opposite side totally preserved, 7 patients (12.5%) with intact lavator ani muscle and part of the ischioanal fat bilaterally dissected, and 2 patients (3.6%) with part of the ischioanal fat and intact lavator ani muscle dissected unilaterally and the muscle on the opposite side partially preserved.The common complications included sexual dysfunction (5/41, 12.2%), perineal complications (7/56,12.5%), urinary retention (4/56, 7.1%), and chronic perineal pain (3/56, 5.4%).A positive circumferential margin was demonstrated in 3 (5.4%) patients, and intraoperative perforations occurred in 2 (3.6%) patient.The local recurrence was 3.6% at a median follow-up of 35 months (range, 12-60 months).CONCLUSIONS: With adequate preoperative chemoradiotherapy, TS-ELAPE is safe and feasible for advanced low rectal cancer with acceptable oncological outcomes.