title: Fistula-associated anal adenocarcinoma: good results with aggressive therapy.
abstract: OBJECTIVE
  To evaluate the clinical features, pathology, treatment, and outcome of patients with fistula-associated anal adenocarcinoma.
  
  
  METHODS
  We identified 14 patients with histologically proven fistula-associated anal adenocarcinoma. We reviewed their medical records and pathology specimens to characterize their presentation, treatment, and clinical outcome.
  
  
  RESULTS
  Nine patients presented with a persistent fistula, 3 with a perianal mass, 1 with pain and drainage, and 1 with a recurrent perianal abscess. The average age at time of diagnosis was 59 (range, 37-76) years. Eleven patients had preexisting chronic anal fistulas. Ten had Crohn's disease, and 1 had previously received pelvic radiation therapy. The diagnosis of cancer was suspected during physical examination in 6 of the 14 patients (43 percent). Twelve patients had extensive local disease at presentation. Primary abdominoperineal resection was performed in 11 patients, 7 following neoadjuvant chemoradiation. Six patients received postoperative chemotherapy, and 2 received postoperative radiation. Four patients died with metastatic disease. The remaining 10 patients are alive without evidence of disease at a mean follow-up of 64.3 (range, 14-149) months.
  
  
  CONCLUSIONS
  The diagnosis of fistula-associated anal adenocarcinoma is often unsuspected. Most patients can be cured with aggressive surgical and adjuvant chemoradiotherapy.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware St. SE, MMC 195, Minneapolis, Minnesota 55455, USA. gaert015@umn.edu
authors.forename: Wolfgang B
authors.initials: WB
authors.lastname: Gaertner
authors.forename: Gonzalo F
authors.initials: GF
authors.lastname: Hagerman
authors.forename: Charles O
authors.initials: CO
authors.lastname: Finne
authors.forename: Karim
authors.initials: K
authors.lastname: Alavi
authors.forename: Jose
authors.initials: J
authors.lastname: Jessurun
authors.forename: David A
authors.initials: DA
authors.lastname: Rothenberger
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D001706:Biopsy; D013505:Digestive System Surgical Procedures / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D012003:Rectal Fistula / Q000150:complications / Q000473:pathology / Q000628:therapy*; D012004:Rectal Neoplasms / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000379:methods