Fistula-associated anal adenocarcinoma: good results with aggressive therapy.
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.
Gaertner
Wolfgang B
WB
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
Hagerman
Gonzalo F
GF
Finne
Charles O
CO
Alavi
Karim
K
Jessurun
Jose
J
Rothenberger
David A
DA
Madoff
Robert D
RD
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