Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Anal Cancer

Outcomes following local excision of early anal squamous cell carcinomas of the anal canal and perianal margin

“…This study shows that, after LE of ASCCs, complete excision is more common if performed for PATs compared to ACTs when using a histological margin clearance of >1 mm [10]. ACTs treated with surgery/ablation compared to radiotherapy or chemoradiotherapy [25].…”

“…Other studies have reported favourable outcomes with the use of radiotherapy, but evidence relating to the sequence of LE, either before or after radiotherapy, and radiotherapy dosage remains inconclusive [9]. Guidelines published by specialty associations in the UK, USA and Europe all recommend that T1N0 tumours can be adequately managed with LE providing adequate surgical margins are obtained [3,4,10] although there is little guidance on risk stratification to guide the use of adjuvant therapy.…”

“…A study based on data from the Nordic Cancer Registry suggested that the addition of postoperative chemoradiotherapy improved survival outcomes in patients undergoing LE for T1- [11,12]. Perianal tumours (PATs) were subsequently redefined as ASCCs within 5 cm of the anal margin [13], with UK guidelines stating that a distance of >1 mm from the invasive tumour component could be considered a clear margin [10].…”

Early stage anal margin cancer: towards evidence‐based management

“…These guidelines state that a poorly differentiation histology is a contra‐indication to LE, but as Table indicates, there is a paucity of data to support this. The 2017 ACPGBI guidelines state that ‘the tumour should be excised with a margin of normal perianal skin and deeper tissue’ – but without defining a clear margin. Thus, there is a dilemma.…”

Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review

“…These findings correspond with recent guidelines published. The Association of Coloproctology of Great Britain and Ireland suggests that HIV-positive MSM would most likely benefit from electrocautery but did not state a specific preference on topical treatments [ 46 ], whereas The American Society of Colon and Rectal Surgeons also advises no preference between ablative treatments, imiquimod, 5-fluorouracil, trichloroacetic acid and cidofovir for the treatment of low- and high-grade dysplasias [ 47 ]. The Italian Society of Colorectal Surgery recommends that topical treatments could be a good compromise between surgical treatment and the watch and wait approach.…”