Salvage abdominoperineal resection for squamous cell anal cancer: a 30-year single institution experience

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

A systematic review of outcomes after salvage abdominoperineal resection for persistent or recurrent anal squamous cell cancer

“…Table summarizes the indications and mean time to salvage APR for persistent or recurrent SCCA. Time to salvage APR was reported in 11 studies with the weighted median time to salvage APR 2.6 months (IQR 2.6–5.0 months, six studies) for persistent disease and 27.6 months (IQR 15.0–32.7 months, five studies) for recurrent disease .…”

“…There were two studies in which all patients received 5-fluorouracil (5-FU) with mitomycin C (MMC) [18,22] and one study in which all patients received 5-FU with cisplatin [19]. Seventeen studies had patients who received a combination of 5-FU, MMC and cisplatin [8,9,13,14,16,17,20,21,23,24,27,[30][31][32][33][34]37]. Patients were treated primarily with bleomycin or carboplatin with 5-FU in one study [25].…”

“…Table 3 summarizes the indications and mean time to salvage APR for persistent or recurrent SCCA. Time to [20,21,23,28,37].…”

Sarcopenia is associated with worse overall survival in patients with anal squamous cell cancer

“…ASCC has one of the most rapidly rising incidences of all malignancies, particularly among women, young black men, and the elderly 1 . Although a majority of patients with ASCC are cured with chemoradiation, those who have persistent or recurrent disease do poorly, with a 5‐year survival rate of 40% to 60% 14‐16 . Identification of patients at risk for treatment failure or poor response is, therefore, useful in the treatment of ASCC as some of these risk factors may be modifiable.…”

“…It is likely that the small numbers in our study limit our ability to demonstrate a significant difference in disease course of sarcopenic patients. Given the relative rarity of ASCC compared with other malignancies, it is a historically understudied disease with much of the literature based on small cohorts of patients 15,17,26 . We suspect that a larger patient population would demonstrate a stronger association between sarcopenia and outcomes for patients with ASCC.…”