Salvage Abdominoperineal Resection for Squamous Cell Anal Cancer: A 30-Year Single-Institution Experience

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2018 Apr 26

PMID 29691737

Citations 14

Authors

J A W Hagemans

S E Blinde

J J Nuyttens

W G Morshuis

M A M Mureau

J Rothbarth

C Verhoef

J W A Burger

Affiliations

Soon will be listed here.

Abstract

Background: Failure of chemoradiotherapy (CRT) for anal squamous cell carcinoma (SCC) results in persistent or recurrent anal SCC. Treatment with salvage abdominoperineal resection (APR) can potentially achieve cure. The aims of this study are to analyze oncological and surgical outcomes of our 30-year experience with salvage APR for anal SCC after failed CRT and identify prognostic factors for overall survival (OS).

Methods: All consecutive patients who underwent salvage APR between 1990 and 2016 for histologically confirmed persistent or recurrent anal SCC after failed CRT were retrospectively analyzed.

Results: Forty-seven patients underwent salvage APR for either persistent (n = 24) or recurrent SCC (n = 23). Median OS was 47 months [95% confidence interval (CI) 10.0-84.0 months] and 5-year survival was 41.6%, which did not differ significantly between persistent or recurrent disease (p = 0.551). Increased pathological tumor size (p < 0.001) and lymph node involvement (p = 0.014) were associated with impaired hazard for OS on multivariable analysis, and irradical resection only (p = 0.001) on univariable analysis. Twenty-one patients developed local recurrence after salvage APR, of whom 8 underwent repeat salvage surgery and 13 received palliative treatment. Median OS was 9 months (95% CI 7.2-10.8 months) after repeat salvage surgery and 4 months (95% CI 2.8-5.1 months) following palliative treatment (p = 0.055).

Conclusions: Salvage APR for anal SCC after failed CRT resulted in adequate survival, with 5-year survival of 41.6%. Negative prognostic factors for survival were increased tumor size, lymph node involvement, and irradical resection. Patients with recurrent anal SCC after salvage APR had poor prognosis, irrespective of performance of repeat salvage surgery, which never resulted in cure.

Citing Articles

Factors Influencing Outcomes and Survival in Anal Cancer.

Temperley H, Mac Curtain B, OSullivan N, Mulhall C, Temperley T, Mehigan B Curr Oncol. 2024; 31(9):5151-5163.

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Anal carcinoma - exploring the epidemiology, risk factors, pathophysiology, diagnosis, and treatment.

English K World J Exp Med. 2024; 14(3):98525.

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Oncologic Outcomes of Salvage Abdominoperineal Resection for Anal Squamous Cell Carcinoma Initially Managed with Chemoradiation.

Rosen R, Quezada-Diaz F, Gonen M, Karagkounis G, Widmar M, Wei I J Clin Med. 2024; 13(8).

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Salvage Treatment of Recurrent or Persistent Anal Squamous Cell Carcinoma: The Role of Multi-modality Therapy.

Damron E, McDonald J, Rooney M, Das P, Ludmir E, Minsky B Clin Colorectal Cancer. 2024; 23(1):85-94.

PMID: 38216367 PMC: 11874619. DOI: 10.1016/j.clcc.2023.12.002.

Estimating Risk of Locoregional Failure and Overall Survival in Anal Cancer Following Chemoradiation: A Machine Learning Approach.

Chen K, Goffredo P, Hu D, Joisa C, Guillem J, Gomez S J Gastrointest Surg. 2023; 27(9):1925-1935.

PMID: 37407899 PMC: 10528925. DOI: 10.1007/s11605-023-05755-0.

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