Extralevator abdominoperineal excision (ELAPE) has been an important surgical procedure for low advanced rectal cancer. In addition to reducing the local recurrence rate, ELAPE might increase the incidence of urogenital nerve injury due to the removal of more surrounding tissues compared with conventional operation. We supposed that the protection of pelvic plexus, pudendal nerve and neurovascular bundle is feasible during the perineal phase of ELAPE operation, which might help to retain the urinary and sexual function postoperatively. Under the guidance of preoperative MRI staging, combine the vertical infiltration depth and circumferential extension of the tumor, individualized ELAPE technology might reduce the surgical trauma and protect the perineal nerves with acceptable oncological outcomes.