The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Anal Squamous Cell Cancers (Revised 2018)

Stewart, David B.; Gaertner, Wolfgang B.; Glasgow, Sean C.; Herzig, Daniel O.; Feingold, Daniel L.; Steele, Scott R.

doi:10.1097/dcr.0000000000001114

Cited by 125 publications

(126 citation statements)

References 156 publications

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“…The latest practice guidelines for colon and rectal surgeons have provided only a weak recommendation for both screening and surveillance of populations at risk of anal dysplasia. 32 In contrast, the data from the current study strongly suggests that for PLWH whose anal HSIL is treated and properly surveilled, the risk of progression to cancer is diminished, despite significant post-EA recurrence rates.…”

Section: Discussioncontrasting

confidence: 65%

“…Despite slight variations in patient cohort characteristics and a longer median follow‐up in these series, one would expect to note 4 to 6 patients progressing to cancer within 12.2 months by adopting similar progression rates to the current study cohort. The latest practice guidelines for colon and rectal surgeons have provided only a weak recommendation for both screening and surveillance of populations at risk of anal dysplasia . In contrast, the data from the current study strongly suggests that for PLWH whose anal HSIL is treated and properly surveilled, the risk of progression to cancer is diminished, despite significant post‐EA recurrence rates.…”

Section: Discussionmentioning

confidence: 61%

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Electrocautery ablation of anal high‐grade squamous intraepithelial lesions: Effectiveness and key factors associated with outcomes

Gaisa

Liu

Deshmukh

et al. 2020

Cancer

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Background Electrocautery ablation (EA) is a common treatment modality for patients with anal high‐grade squamous intraepithelial lesions (HSILs), but to the authors' knowledge its effectiveness has been understudied. The objective of the current study was to determine ablation outcomes and to identify clinicopathological factors associated with postablation disease recurrence. Methods A total of 330 people living with HIV with de novo intra‐anal HSIL who were treated with EA from 2009 to 2016 were studied retrospectively. Using long‐term, surveillance high‐resolution anoscopy biopsy data, treatment failures were classified as local recurrence (HSIL noted at the treated site at the time of surveillance) or overall recurrence (HSIL noted at treated or untreated sites). The associations between these outcomes and clinical factors were analyzed using Cox proportional hazards models. Results Approximately 88% of participants were men who have sex with men. The median age of study participants was 45.5 years (range, 35‐51 years) and approximately 49% had multiple index HSILs (range, 2‐6 index HSILs). At a median of 12.2 months postablation (range, 6.3‐20.9 months postablation), approximately 45% of participants had developed local recurrence whereas 60% had developed overall recurrence. Current cigarette smoking, HIV viremia (HIV‐1 RNA ≥100 copies/mL), and multiple index HSILs were found to be predictive of local recurrence. Overall recurrence was more common in current smokers and those with multiple index lesions. In multivariable models that included human papillomavirus (HPV) genotypes, baseline and persistent infections with HPV‐16 and/or HPV‐18 were found to be significantly associated with both local and overall recurrence. Conclusions EA is an effective treatment modality for anal HSIL in people living with HIV, but rates of disease recurrence are substantial. Multiple index HSILs, HIV viremia, current cigarette smoking, and both baseline and persistent infection with HPV‐16 and/or HPV‐18 appear to negatively impact treatment success. Ongoing surveillance is imperative to capture recurrence early and improve long‐term treatment outcomes.

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 61%

Electrocautery ablation of anal high‐grade squamous intraepithelial lesions: Effectiveness and key factors associated with outcomes

Gaisa

Liu

Deshmukh

et al. 2020

Cancer

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“…For the final analysis, eight papers fulfilled the inclusion criteria and were selected ( Figure 1). Five are from the United States of America (USA) [17][18][19][20][21] and three are from Europe [22][23][24]. Considering the European recommendations, one was from the European AIDS Clinical Society [22] and one each from Spain [23] and Germany/Austria [24].…”

Section: Resultsmentioning

confidence: 99%

“…Considering the European recommendations, one was from the European AIDS Clinical Society [22] and one each from Spain [23] and Germany/Austria [24]. Seven of the eight papers targeted HIV-positive patients [17][18][19][20][22][23][24], while the eighth focused exclusively on solid-organ transplant recipients [21]. In the case of HIV-positive patient recommendations [17][18][19][20][22][23][24], all of them included HIV-positive MSM as a screening group.…”

Section: Resultsmentioning

confidence: 99%

Recommendations Favoring Anal Cytology as a Method for Anal Cancer Screening: A Systematic Review

Albuquerque

Rios

Schmitt

2019

Cancers

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Clinicians are increasingly facing the decision of performing anal cancer screening in high-risk groups. Anal cytology is commonly the first approach. We systematically reviewed recommendations favoring anal cytology for anal cancer screening. Three databases were searched: PubMed, Scopus, and Embase, from January 2007 to 12 September 2019. The references cited by the retrieved articles and the websites of relevant organizations were also searched without language restrictions. Studies reporting guidelines from regional or national societies, institutes, or groups were included. Eight papers met the inclusion criteria and were selected, five were from the United States of America (USA) and three from Europe. There were no national recommendations published. There was one guideline specifically for solid-organ transplant recipients. The other seven targeted HIV-positive patients, with HIV-positive men who have sex with men (MSM) included as a screening group in all of these. Two recommendations favored screening in all HIV-positive patients. Five recommendations targeting HIV-positive patients made considerations about the cytology follow-up, recommending at least annual cytology in case of a normal result, and in case of squamous cytological abnormalities, a referral for anoscopy/high-resolution anoscopy. There were no recommendations for upper and lower age limits for screening. In conclusion, several societies recommend anal cancer screening using anal cytology in HIV-positive MSM patients. There is a lack of screening recommendations for other high-risk groups, with only one society recommending screening in transplant recipients.

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“…As a result, early and frequent evaluation is necessary to identify persistent or recurrent disease. The American Society of Colon and Rectal Surgeons (ASCRS) recommends posttreatment evaluation starting with a digital rectal examination, anoscopy, and inguinal palpation at 8 to 12 weeks after the completion of chemoradiation and then every 3 to 6 months for 5 years . The National Comprehensive Cancer Network (NCCN) recommends posttreatment evaluation with a digital rectal examination at 8 to 12 weeks after the completion of chemoradiation followed by digital rectal examination every 3 to 6 months for 5 years, inguinal node palpation every 3 to 6 months for 5 years, and anoscopy every 6 to 12 months for 3 years .…”

Section: Discussionmentioning

confidence: 99%

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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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Anal Squamous Cell Cancers (Revised 2018)

Cited by 125 publications

References 156 publications

Electrocautery ablation of anal high‐grade squamous intraepithelial lesions: Effectiveness and key factors associated with outcomes

Electrocautery ablation of anal high‐grade squamous intraepithelial lesions: Effectiveness and key factors associated with outcomes

Recommendations Favoring Anal Cytology as a Method for Anal Cancer Screening: A Systematic Review

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

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