title: Wide local excision for Buschke-Löwenstein tumor or circumferential carcinoma in situ.
abstract: OBJECTIVE
  This study aimed to evaluate the outcome of patients with Buschke-Löwenstein tumor or circumferential anal carcinoma in situ who underwent wide local excision with flap or skin graft coverage of the wound.
  
  
  METHODS
  A retrospective review was conducted of all patients operated at Kaiser Permanente Los Angeles Medical Center during a 6-year period. Outcome measures included postoperative complications, functional results, recurrence rate, and re-intervention rate.
  
  
  RESULTS
  Of 152 patients operated for dysplastic anal lesions or tumors, 10 (7%) underwent wide local excision for Buschke-Löwenstein tumor or circumferential anal carcinoma in situ [men 70%, mean age 36 years]. Median duration of symptoms was 5 years. Eighty percent of patients had prior operations and 50% were positive for the human immunodeficiency virus. Mean size of the lesion was 41 cm(2). Microscopic margin positivity was noted in 60%. Wound was closed with house advancement flap in majority of patients. Only one patient had fecal diversion. Median length of stay was 2 days. Postoperative complications were noted in 50% of patients. Rate of transient postoperative incontinence was 30%. Recurrent disease was noted in 3 patients with the human immunodeficiency virus [median follow-up: 18 months]. All recurrences were treated with local fulguration or medication.
  
  
  CONCLUSIONS
  Wide local excision with flap or skin graft coverage is an option for patients with Buschke-Löwenstein tumor or circumferential anal carcinoma in situ. Close postoperative surveillance is advised due to the risk of recurrent disease, especially in patients with the human immunodeficiency virus.
authors: Section of Colon and Rectal Surgery, Department of Surgery, Kaiser Permanente, 4760 Sunset Boulevard, Los Angeles, CA, USA. maher.a.abbas@kp.org
authors: Maher A
authors: MA
authors: Abbas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003218:Condylomata Acuminata / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012008:Recurrence; D012189:Retrospective Studies; D016038:Skin Transplantation; D013524:Surgical Flaps; D055815:Young Adult