Survival following salvage abdominoperineal resection for persistent and recurrent squamous cell carcinoma of the anus: do these disease categories affect survival?

Severino, Natalia Parisi; Chadi, Sami A.; Rosen, Lester; Coiro, Saverio; Choman, Eran; Berho, Mariana; Wexner, Steven D.

doi:10.1111/codi.13288

Cited by 23 publications

(24 citation statements)

References 17 publications

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“…In terms of OS, the results of the current series are comparable with previously published data from retrospective series or randomized trials [3][4][5][6][7][8][9][10][11][12][13][14] . In ACC and AMC, surgery should be considered at the time of recurrence as a salvage treatment [15] .…”

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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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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“…Twenty‐five studies provided definitions of persistent vs recurrent disease . Twenty‐one studies used 6 months to differentiate persistent from recurrent disease. One study separated recurrent disease into early (between 6 and 24 months) and late (after 24 months).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty‐one studies used 6 months to differentiate persistent from recurrent disease. One study separated recurrent disease into early (between 6 and 24 months) and late (after 24 months). The remaining four studies did not provide a time period to differentiate persistent from recurrent disease.…”

Section: Resultsmentioning

confidence: 99%

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

Sarkaria

Merchant

et al. 2019

Colorectal Disease

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Aim Up to 30% of patients with squamous cell cancer of the anus (SCCA) will require a salvage abdominoperineal resection (APR) for either persistent or recurrent disease. The objective of this study was to assess cancer‐related outcomes in patients with (i) persistent or (ii) recurrent SCCA. Method Embase and MEDLINE were searched. Publications were included if they assessed overall survival (OS), disease‐free survival (DFS) and locoregional recurrence or metastatic disease after salvage APR for persistent or recurrent SCCA. Results A total of 28 retrospective case series (study size ranged from nine to 111) met our inclusion criteria. The median time to salvage APR was 2.6 months [interquartile range (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. The median 5‐year OS from the time of salvage APR was 45.0% (IQR 32.0%–52.3%, 10 studies) for persistent disease and 51.0% (IQR 36.0%–60.9%, 11 studies) for recurrent disease. The median 5‐year DFS following salvage APR was 44.0% (IQR 29.5%–53.0%, 10 studies) for all patients. Following salvage APR, the median locoregional recurrence rate was 23.5% (IQR 15.8%– 46.9%, 19 studies) and 9.0% (IQR 6.4%–13.3%, 16 studies) of patients developed metastatic disease after salvage APR. Conclusion Our review characterizes the best evidence for outcomes following salvage APR for patients with persistent or recurrent SCCA. The evidence is limited by the quality of included studies, as many were single centre case series.

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“…van der Wal et al [30] , reported a survival rate of 47% at 5 years in 17 patients with recurrent or persistent disease after surgical salvage treatment. A recent study of Severino et al [31] showed that patients with persistent disease or early recurrence had a significantly higher dis- ease stage than patients with late recurrence. Akbari et al [22] reported that patients with persistent disease had worse prognosis than those with recurrent disease.…”

Section: Oncological Results Of Surgical Salvage Surgerymentioning

confidence: 98%

Results of Surgical Salvage Treatment for Anal Canal Cancer: A Retrospective Analysis with Overview of the Literature

et al. 2017

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Background and Aim: Chemoradiotherapy (CRT) is the gold standard treatment for anal cancer, which permits the maintenance of the anal function. However, about 30-40% of patients develop local disease progression, for which surgery represents a good salvage therapy. The aim of this study is to evaluate survival and morbidity rate in patients who undergo salvage surgery in our single institution, with an overview of the literature. Methods: A retrospective study was carried out on patients who underwent surgical treatment of anal canal cancer after failure of CRT. We evaluated overall survival at 1, 3, and 5 years and postoperative morbidity rate. Results: Twenty patients who underwent radical surgery with abdominoperineal resection were included in the study. The survival rates at 1, 3, and 5 years were 75, 60, and 37.4%; with a disease-free survival of 67, 53, and 35%, respectively. There was no postoperative mortality. The morbidity rate was 35%. Conclusion: Surgery represents the recommended therapy for persistent or recurrent anal canal cancer after CRT, with a good survival rate and an acceptable morbidity.

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Survival following salvage abdominoperineal resection for persistent and recurrent squamous cell carcinoma of the anus: do these disease categories affect survival?

Abstract: Persistent and recurrent disease does not show any significant difference in survival, but patients with late recurrence may have a better prognosis.

Cited by 23 publications

References 17 publications

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

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

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

Results of Surgical Salvage Treatment for Anal Canal Cancer: A Retrospective Analysis with Overview of the Literature

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