Salvage abdominoperineal resection in anal epidermoid cancer.
BACKGROUND
In the management of isolated locoregional failure after (chemo)radiation therapy for anal epidermoid cancer, salvage abdominoperineal resection (APR) is the treatment of choice. The results of a 15-year consecutive population-based series are reviewed.


METHODS
Details of all patients with anal epidermoid cancer treated from 1985 to 2000 in the Stockholm Health Care Region were recorded prospectively. Among 308 patients with biopsy-proven anal epidermoid cancer, there have been 39 isolated locoregional failures after sphincter-preserving therapy. Thirty-five patients have undergone salvage APR. The medical records of these 35 patients were reviewed retrospectively with regard to surgical and oncological results.


RESULTS
There were no postoperative deaths. There was considerable morbidity related to the perineal wound, with postoperative perineal infections in 13 patients and delayed healing beyond 3 months in 23 patients. Complications unrelated to the perineal wound were found in 13 patients. The crude 5-year survival rate for the 35 patients was 52 per cent (median follow-up 33 months). Patients with persistent disease fared significantly worse than those with locoregional recurrence (crude 5-year survival rate 33 versus 82 per cent; P < 0.05, log rank test).


CONCLUSIONS
Salvage APR in anal epidermoid cancer is associated with a high complication rate but may result in long-term survival.
Nilsson
P J
PJ
Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden. per.nilsson@ersta.se
Svensson
C
C
Goldman
S
S
Glimelius
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology; D016019:Survival Analysis