Abdominoperineal Resection for Squamous Cell Anal Carcinoma: Survival and Risk Factors for Recurrence

Lefèvre, Jérémie H.; Corté, Hélène; Tiret, Emmanuel; Boccara, David; Chaouat, Marc; Touboul, E.; Svrcek, Magali; Lefrançois, Magalie; Shields, Conor; Parc, Yann

doi:10.1245/s10434-012-2485-1

Cited by 58 publications

(72 citation statements)

References 30 publications

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“…We found, as should be expected, that patients with positive lymph nodes and/or positive resection margins had worse overall survival. Our findings confirm those of previous studies that have linked positive margins and node status to survival outcomes . It is clear that positive lymph nodes and positive resection margins lead to worse survival as both of these factors contribute to increased local recurrence after salvage APR.…”

Section: Discussionsupporting

confidence: 90%

“…Both of these independent predictors of survival are indicators of advanced local disease, regional disease, and/or aggressive biology. Akbari et al demonstrated that patients with positive margins did not survive more than 2 years after salvage APR, while another study reported a 0% 5‐year survival for patients with positive margins following salvage APR . Patients with positive lymph nodes at the time of salvage APR had a median survival of 8.1 months compared with 38.1 months for patients with negative nodes .…”

Section: Discussionmentioning

confidence: 99%

“…Hence, it is important to determine the factors influencing prognosis following salvage surgery. Size, margin positivity, and lymphovascular invasion have been associated with survival in previous reports . Several investigations with small patient populations have tried to determine if the indication for APR (persistent vs recurrent disease) is a predictor of survival.…”

Section: Introductionmentioning

confidence: 99%

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Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

Fields

Melnitchouk

Senturk

et al. 2019

Journal of Surgical Oncology

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Background/Objectives The first‐line treatment for anal squamous cell carcinoma is Nigro protocol chemoradiotherapy. Some patients will fail curative intent chemoradiotherapy and have persistent disease while others may have an initial response followed by disease recurrence. The goal of this study is to investigate survival in anal squamous cell carcinoma patients who fail first‐line treatment. Methods The National Cancer Database (2004‐2013) was used to identify patients with anal squamous cell carcinoma. The primary outcome was overall survival. Results There were 256 patients in the early salvage group who underwent abdominoperineal resection (APR) within 6 months of completing chemoradiotherapy and 181 patients in the late salvage group who had APR 6 months or more after completion of chemoradiotherapy. Both groups of patients had similar tumor size (45 vs 50 mm; P = 0.07) and rate of positive margins (21.5% vs 15.6%;P = 0.13). There was no significant difference in overall survival between early and late salvage APR (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.50‐1.32; P = 0.40). Conclusions The overall survival of anal squamous cell carcinoma patients undergoing early vs late salvage APR after failure of chemoradiotherapy is similar. As a result, patients with persistent disease should be offered surgery just as readily as those with recurrent disease.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

Fields

Melnitchouk

Senturk

et al. 2019

Journal of Surgical Oncology

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“…The postoperative mortality rate in this study was comparable to previously reported rates, which ranged from 0 to 3% [3,11,16] ; however, our postoperative morbidity rate was at the lower end of the range of previous series, where complication rates from 23.7 to 100% were reported [3,11,[16][17][18] . However, in the absence of efficient curative chemotherapy or treatment, salvage surgery can be a reasonable course of curative action [19] .…”

Section: Discussionsupporting

confidence: 86%

Surgery Is an Effective Option after Failure of Chemoradiation in Cancers of the Anal Canal and Anal Margin

Delhorme

Séverac²,

Waissi³

et al. 2017

Oncology

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Background: Surgery for anal canal cancer (ACC) and anal margin cancer (AMC) is the only curative option after failure of chemoradiotherapy (CRT). This study aimed to determine the efficacy of surgery for ACC or AMC after failed CRT. Methods: This was a single-centre, retrospective study of 161 patients initially treated with CRT. We compared the survival rates of patients successfully treated by CRT with those of patients whose CRT failed (both surgically salvaged and treated palliatively). Results: Thirty-one patients underwent surgery with curative intent, 20 received palliative treatment after failure of CRT, and 110 had effective CRT. The 5-year overall survival (OS) rate was significantly higher among patients with successful CRT than among patients who underwent surgery with curative intent (86 vs. 66%, p < 0.001). On the other hand, the 5-year OS of patients treated with curative surgery was significantly better than that of patients who underwent palliative treatment (66 vs. 13.5%, p < 0.001). The postoperative morbidity and mortality rates were 32 and 3%, respectively. Considering patients with failed CRT, curative surgery was the only factor prognostic of favourable OS in the multivariate analysis. Conclusion: Curative surgery after failure of CRT for ACC or AMC remains an effective treatment to improve survival in two-thirds of cases, resulting in high but manageable morbidity.

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“…Salvage radical surgery, typically in the form of abdomino-perineal resection, offers a second chance for cure in these patients with R0 resection (microscopic negative margins) [6]. However, many institutional series report post-salvage resection positive margin (R1/R2) rates between 16 % and 20 % [7–10], and as high as 32 % in population registries [11]. For patients with R1/R2 resections, post-salvage survival rates are dismal – typically zero survival at 3–5 years [5, 7, 10, 11] – rates equivalent to those observed in patients with local relapse not undergoing salvage surgery [5], thus questioning patient benefit from such radical surgery.…”

Section: Introductionmentioning

confidence: 99%

The assessment of local response using magnetic resonance imaging at 3- and 6-month post chemoradiotherapy in patients with anal cancer

et al. 2016

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ObjectivesTo assess the use of MRI-determined tumour regression grading (TRG) in local response assessment and detection of salvageable early local relapse after chemoradiotherapy (CRT) in patients with anal squamous cell carcinoma (ASCC).MethodsFrom a prospective database of patients with ASCC managed through a centralised multidisciplinary team, 74 patients who completed routine post-CRT 3- and 6-month MRIs (2009–2012) were reviewed. Two radiologists blinded to the outcomes consensus read and retrospectively assigned TRG scores [1 (complete response) to 5 (no response)] and related these to early local relapse (within 12 months) and disease-free survival (DFS).ResultsSeven patients had early local relapse. TRG 1/2 scores at 3 and 6 months had a 100 % negative predictive value; TRG 4/5 scores at 6 months had a 100 % positive predictive value. All seven patients underwent salvage R0 resections. We identified a novel ‘tram-track’ sign on MRI in over half of patients, with an NPV for early local relapse of 83 % at 6 months. No imaging characteristic or TRG score independently prognosticated for late relapse or 3-year DFS.ConclusionsPost-CRT 3- and 6-month MRI-determined TRG scores predicted salvageable R0 early local relapses in patients with ASCC, challenging current clinical guidelines.Key Points• Post-chemoradiotherapy MRI (3 and 6 months) helps local response assessment in ASCC.• The MRI-TRG system can be used reproducibly in patients with ASCC.• The TRG system facilitates patient selection for examination under anaesthesia and biopsy.• The use of MRI-TRG predicts for detection of salvageable early local relapses.• The TRG system allows for a standardised follow-up pathway.Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-016-4337-z) contains supplementary material, which is available to authorized users.

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Abdominoperineal Resection for Squamous Cell Anal Carcinoma: Survival and Risk Factors for Recurrence

Abstract: This study describes the largest single series of APR for anal carcinoma. Major prognostic factors for survival and recurrence were T status and involved margin. The 5-year overall survival was 60 %.

Cited by 58 publications

References 30 publications

Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

Surgery Is an Effective Option after Failure of Chemoradiation in Cancers of the Anal Canal and Anal Margin

The assessment of local response using magnetic resonance imaging at 3- and 6-month post chemoradiotherapy in patients with anal cancer

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