title: Abdominoperineal resection for squamous cell anal carcinoma: survival and risk factors for recurrence.
abstract: BACKGROUND
  Despite the results of combined chemoradiation therapy for anal canal squamous cell carcinoma (SCC), up to 30 % of patients will undergo abdominoperineal resection (APR). The aim of this study was to evaluate oncologic outcomes, survival, and recurrence, following APR for anal canal SCC performed in a single center over a 13-year period.
  
  
  METHODS
  All patients who underwent APR for anal canal SCC between 1996 and 2009 were retrospectively included. Demographic data, details on treatments, pathological report, and follow-up were noted. Survival curves were plotted using the Kaplan-Meier method and potential prognostic factors were evaluated using Cox proportional hazards models.
  
  
  RESULTS
  A total of 105 patients (77 women) were included. Indications for APR included tumor persistence (n = 42; 40 %), recurrence (n = 55; 52.4 %), or a contraindication to radiotherapy (n = 8; 7.6 %). Median follow-up was 33.3 months (range, 1.5-174.3 months). Overall survival and disease-free survival were, respectively, 61 and 48 % at 5 years. In multivariate analysis, tumor stage (T3 or T4), positive margin on pathologic examination and existence of distant metastases at the time of the surgery were associated with a poor prognosis. The indication for APR (persistent vs recurrent disease), gender, concurrent HIV infection, or performance of a VRAM flap did not influence OS or DFS. Overall recurrence rate was 42.6 % (n = 43 of 101). The type of recurrence did not exert a significant effect on survival (p = .4571).
  
  
  CONCLUSIONS
  This study describes the largest single series of APR for anal carcinoma. Major prognostic factors for survival and recurrence were T status and involved margin. The 5-year overall survival was 60 %.
authors: Department of Digestive Surgery, Hôpital Saint-Antoine, AP-HP, Université Pierre et Marie Curie, Paris, France. jeremie.lefevre@sat.aphp.fr
authors: Jérémie H
authors: JH
authors: Lefèvre
authors: Hélène
authors: H
authors: Corte
authors: Emmanuel
authors: E
authors: Tiret
authors: David
authors: D
authors: Boccara
authors: Marc
authors: M
authors: Chaouat
authors: Emmanuel
authors: E
authors: Touboul
authors: Magali
authors: M
authors: Svrcek
authors: Magalie
authors: M
authors: Lefrancois
authors: Conor
authors: C
authors: Shields
authors: Yann
authors: Y
authors: Parc
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D009367:Neoplasm Staging; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D016879:Salvage Therapy; D013524:Surgical Flaps; D015996:Survival Rate