title: Abdominoperineal resection and perineal wound healing in recurrent, persistent, or primary anal carcinoma.
abstract: OBJECTIVE
  Chemoradiotherapy is the standard treatment for squamous cell anal cancer. Salvage abdominoperineal resection (APR) is usually reserved for patients presenting with recurrent or persistent disease. Aim of our study was to review the outcomes of salvage surgery and perineal wound healing with or without a vertical rectus abdominis myocutaneous (VRAM) flap in a single institution over a 6-year period.
  
  
  METHODS
  Data of all patients with biopsy-proven squamous cell anal cancer treated with chemoradiation at the University Medical Center Mannheim were recorded prospectively. Medical records of all patients who underwent salvage surgery for anal carcinoma between June 2008 and June 2014 were reviewed with regard to surgical and oncological outcomes.
  
  
  RESULTS
  One hundred twenty-four patients received chemoradiation with a 5-year overall survival of 79 %. Seventeen patients required (salvage) APR for recurrent (n = 8), persistent (n = 7), or primary anal carcinoma (n = 2). Median overall survival was 33.4 months. Median duration until completion of perineal wound healing was shorter in the VRAM group (17 vs. 24.5 weeks; p = 0.0541).
  
  
  CONCLUSIONS
  Salvage APR has a reasonable chance of long-time survival. Perineal reconstruction with a VRAM flap may reduce the duration until completion of perineal wound healing.
authors.affiliation: Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Hardt
authors.affiliation: Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Mai
authors.affiliation: Department of Medical Statistics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Weiß
authors.affiliation: Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany. peter.kienle@umm.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Kienle
authors.affiliation: Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Magdeburg
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D010502:Perineum / Q000473:pathology* / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D016879:Salvage Therapy; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Anal carcinoma; Perineal reconstruction; Salvage surgery; Vertical rectus abdominis myocutaneous flap