title: Outcomes of salvage surgery for epidermoid carcinoma of the anus following failed combined modality treatment.
abstract: BACKGROUND
  Chemoradiation is first-line therapy for epidermoid carcinoma of the anus (ECA). Surgery is reserved for treatment failures. The authors report outcomes after salvage procedures for ECA.
  
  
  METHODS
  All treatment failures managed with radical surgery between 1998 and 2006 in our institution were reviewed. The Kaplan-Meier method was used for survival analysis. Log-rank and Cox regression were used for univariate and multivariate analysis, respectively.
  
  
  RESULTS
  Fifty-one patients underwent salvage abdominoperineal resection for locoregional failure. Five-year overall survival after abdominoperineal resection was 29% (median, 22 months). Age, gender, human immunodeficiency virus status, tumor-node-metastasis stage, node status, and failure type did not predict survival. Negative resection margin was most strongly associated with improved overall and disease-free survival (P = .03 and P < .0001, respectively). Median survival for patients undergoing inguinal lymph node dissection for regional recurrence (n = 6) was 11 months, with freedom from cancer achieved in 2 of 6 patients.
  
  
  CONCLUSIONS
  Recurrent anal carcinoma after primary chemoradiotherapy carries a poor prognosis. Salvage abdominoperineal resection offers a potential for long-term survival.
authors.affiliation: Division of General Surgery, University of British Columbia, Vancouver, BC, Canada. gareth.eeson@lshtm.ac.uk
authors.forename: Gareth
authors.initials: G
authors.lastname: Eeson
authors.forename: Marcus
authors.initials: M
authors.lastname: Foo
authors.forename: Stephen
authors.initials: S
authors.lastname: Harrow
authors.forename: Gregor
authors.initials: G
authors.lastname: McGregor
authors.forename: John
authors.initials: J
authors.lastname: Hay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D001955:British Columbia / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents