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Outcomes of Salvage Surgery for Squamous Cell Carcinoma of the Anal Canal

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

For patients with anal canal cancer who fail combined modality treatment (CMT), salvage surgery (SS) offers the potential for long term survival. The literature regarding SS is limited by small patient numbers and/or heterogeneous treatment protocols. We report on a large series of patients initially treated with chemoradiation at a major referral center.

Methods

We identified 60 patients with persistent or recurrent anal cancer who had undergone SS; 20 were excluded. Overall and disease-free survival (OS, DFS) curves were constructed using the Kaplan Meier method. Univariate analysis was done using the Log-Rank test, and multivariable analysis using Cox proportional hazards.

Results

The 40 patients (29 women, 11 men, median age 57) underwent curative intent resection. The initial procedure was multivisceral resection (n = 24), abdominoperineal resection alone (n = 14) or local excision (n = 2). Postoperative mortality was 5%. Postoperative complications were seen in 72%. Median follow-up was 18 months overall and 36 months in survivors. Median OS was 41 months; OS and disease free survival at 5 years were 39% and 30%, respectively. Recurrence was present in 21 patients at time of analysis. Failure was locoregional in 86% (18 of 21) and distant in 48% (10 of 21). Independent predictors of poor OS were male gender, Charlson Comorbidity Score and tumor size. Independent predictors of poor disease free survival were positive margins and lymphovascular invasion.

Conclusion

SS for anal canal cancer was associated with significant morbidity. Long-term survival was achieved in 39% of patients. Comorbidities should guide patient selection, and R0 resection should be the goal.

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ACKNOWLEDGEMENTS

D.E.S. was supported by the Joey and Toby Tanenbaum Fellowship Program in Surgical Oncology, Toronto General Hospital Foundation, University Health Network, Toronto, Canada.

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Authors and Affiliations

  1. Department of Surgery, Mount Sinai Hospital, University of Toronto, Suite 1224, 600 University Avenue, M5G 1X5, Toronto, Ontario, Canada

    Dan E. Schiller, Sundeep Rai, Alexandra Easson & Carol J. Swallow

  2. Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada

    Bernard J. Cummings

  3. Department of Biostatistics, Princess Margaret Hospital, Toronto, Canada

    Lisa W. Le

  4. Division of Surgical Oncology, Toronto Sunnybrook Regional Cancer Center, Toronto, Canada

    Linda Last & Andrew J. Smith

  5. Department of Radiation Oncology, Toronto Sunnybrook Regional Cancer Center, Toronto, Canada

    Phil Davey

  6. Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada

    Alexandra Easson & Carol J. Swallow

Authors
  1. Dan E. Schiller
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  2. Bernard J. Cummings
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  3. Sundeep Rai
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  4. Lisa W. Le
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  5. Linda Last
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  7. Alexandra Easson
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  8. Andrew J. Smith
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  9. Carol J. Swallow
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Corresponding author

Correspondence to Carol J. Swallow.

Additional information

Presented at the 60th Annual Meeting of the Society of Surgical Oncology, Washington, DC, March 17, 2007.

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Schiller, D.E., Cummings, B.J., Rai, S. et al. Outcomes of Salvage Surgery for Squamous Cell Carcinoma of the Anal Canal. Ann Surg Oncol 14, 2780–2789 (2007). https://doi.org/10.1245/s10434-007-9491-8

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  • DOI: https://doi.org/10.1245/s10434-007-9491-8

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