title: Salvage abdominoperineal resection after failure of conservative treatment in anal epidermoid cancer.
abstract: OBJECTIVE
  Radiotherapy alone or with combined chemotherapy is the first therapeutic option for epidermoid carcinoma of the anal canal. Failure of this conservative treatment may benefit of salvage abdominoperineal resection. This study was designed to analyze postoperative outcome and oncologic results in a single anticancer institution.
  
  
  METHODS
  Medical charts of 36 patients (median age, 57.9 years) who underwent salvage abdominoperineal resection after failure of conservative treatment between 1987 and 2002 were reviewed retrospectively. There were 15 patients treated for immediate failure (Group I) and 21 patients for recurrence (Group II). Twenty-two patients have undergone primary use of flap reconstruction of the perineal wound. There were ten rectus abdominis myocutaneous flaps, nine omental flaps, two gracilis muscular flaps, and one combined flap.
  
  
  RESULTS
  There was no postoperative mortality. Median follow-up was 67 (range, 15-155) months. Primary closure of the perineum was obtained in 33 patients (92 percent). Secondary wound breakdown occurred in 23 of 33 patients (70 percent). Complications unrelated to the perineal wound occurred in 13 patients. The overall crude five-year survival after salvage abdominoperineal resection was 69.4 percent. The crude five-year survival in Group I and Group II was 60.7 and 71.5 percent respectively (P = 0.28). The crude five-year, disease-free survival in Groups I and II was 31.1 and 48.2 percent respectively (P = 0.10). Twenty-three patients experienced recurrences after salvage abdominoperineal resection (64 percent) with a mean delay of 30 months.
  
  
  CONCLUSIONS
  Despite high incidence of perineal morbidity, salvage abdominoperineal resection for epidermoid carcinomas of the anal canal has a high long-term survival rate.
authors.affiliation: Department of Oncological and Digestive Surgery, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Ghouti
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
authors.forename: Vincent
authors.initials: V
authors.lastname: Moutardier
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.forename: Valérie
authors.initials: V
authors.lastname: Magnin
authors.forename: Bernard
authors.initials: B
authors.lastname: Lelong
authors.forename: Valérie-Jeanne
authors.initials: VJ
authors.lastname: Bardou
authors.forename: Jean-Robert
authors.initials: JR
authors.lastname: Delpero
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010502:Perineum / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy