title: Sphincter-saving treatment in epidermoid anal cancer: cooperative analysis of 142 patients in five German university surgical centers.
abstract: Five southern German university centers cooperated in comparing the effect of surgical vs. nonsurgical therapy strategies on survival and sphincter preservation in the treatment of anal cancer. A standardized questionnaire was used to evaluate retrospectively (mean follow-up 30 months) treatment strategy and outcome (survival, colostomy rate, colostomy-free survival) in patients treated between 1987 and 1996. Of the 142 patients 65% had squamous cell, 20% basaloid, 6% adeno-, and 1% undifferentiated carcinoma (8% histology not recorded); 9% were classified in UICC stage I, 37% in stage II, 25% in stage III, and 4% in stage IV (25% not recorded). Primary treatment consisted of local excision (10%), excision plus radio- and/or chemotherapy (17%), radiotherapy (20%), radiochemotherapy (28%), or colostomy with or without resection, radiotherapy, and chemotherapy (23%). We observed no difference between these treatment groups in overall (P = 0.43) or colostomy-free survival (P = 0.14, log-rank). Primary colostomy was prevented in 77% of cases and decreased over the years. Mean overall survival (in months) was 42 in stage I, 38 in stage II, and 25 in stage III (P = 0.0013); mean colostomy-free survival was 36 in stage I, 26 in stage II, and 16 in stage III (P = 0.0021, log-rank). Outcome was not significantly related to therapeutic strategy (surgery or radio-chemotherapy. Primary surgical and nonsurgical strategies in treating anal cancer thus produced similar results, although radiochemotherapy is usually recommended for sphincter-endangering anal cancer. Challenges to be met in the future include the prevention of metastasis and long-term preservation of anal sphincter function.
authors.affiliation: Department of Surgery, University of Ulm, Steinhövelstrasse 9, 89070 Ulm, Germany. ludger.staib@medizin.uni-ulm.de
authors.forename: L
authors.initials: L
authors.lastname: Staib
authors.forename: T
authors.initials: T
authors.lastname: Gottwald
authors.forename: T
authors.initials: T
authors.lastname: Lehnert
authors.forename: G
authors.initials: G
authors.lastname: Ruf
authors.forename: J
authors.initials: J
authors.lastname: Sturm
authors.forename: H D
authors.initials: HD
authors.lastname: Becker
authors.forename: E
authors.initials: E
authors.lastname: Farthmann
authors.forename: C
authors.initials: C
authors.lastname: Herfarth
authors.forename: S
authors.initials: S
authors.lastname: Post
authors.forename: M
authors.initials: M
authors.lastname: Trede
authors.forename: H G
authors.initials: HG
authors.lastname: Beger
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D001005:Anus Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D002277:Carcinoma / Q000401:mortality / Q000601:surgery / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D002986:Clinical Trials as Topic; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D013997:Time Factors; D016896:Treatment Outcome