Annals of Coloproctology

Review

Malignant disease,Prognosis and adjuvant therapy

Survival and Operative Outcomes After Salvage Surgery for Recurrent or Persistent Anal Cancer: In Ja Park, George Chang; Ann Coloproctol. 2020;36(6):361-373. Published online December 31, 2020; DOI: https://doi.org/10.3393/ac.2020.12.29

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Anal squamous cell carcinoma (SCC) is a relatively rare cancer comprising less than 2.5% of all gastrointestinal malignancies. The standard treatment for anal SCC is primary chemoradiation therapy which can result in complete regression. After successful treatment, the 5-year survival is approximately 80%. However, up to 30% of patients experience recurrent persistent or recurrent disease. The role of surgery in the treatment of anal cancer, therefore, is limited to the management of recurrent or persistent disease with abdominoperineal resection and/or en bloc adjacent organ excision. Salvage surgery after irradiated anal cancer can be technically demanding in terms of acquisition of oncologically safe surgical margins and minimization of postoperative morbidity. In addition, 5-year survival outcomes after salvage resection have been reported to vary from 23% to 69%. Positive resection margins are generally regarded as the important risk factor associated with poor survival outcome. Perineal wound complications are the most common major postoperative morbidity. Because of the challenges of primary wound closure after salvage abdominoperineal resection, myocutaneous flap reconstruction has been performed to reduce the severity of perianal would complications. We, therefore, descriptively reviewed contemporary published evidence describing the treatment and outcomes after salvage surgery for persistent or recurrent anal SCC.

Citations

Citations to this article as recorded by

Management of Recurrent Anal Cancer
James Blake Littlejohn, Kelly Ann Brister
Surgical Oncology Clinics of North America.2025; 34(1): 91. CrossRef
Prognostic factors associated with worse outcomes following chemoradiation therapy in patients with anal carcinoma
Muhammad Khurrum, Alejandro Cruz, David Schaub, Joseph Gunderson, Andrea Moreno, Daniom Tecle, Amanda Gong, Manijeh Assar, McKenzie Hargis, Danielle Alexandra Dooley, Jose Cruz, Valentine Nfonsam
Colorectal Disease.2025;[Epub] CrossRef
Brazilian Society of Surgical Oncology: Guidelines for the management of anal canal cancer
Marcus Valadão, Rachel P. Riechelmann, José Antonio Cunha e Silva, Jorge Mali, Bruno Azevedo, Samuel Aguiar, Rodrigo Araújo, Mario Feitoza, Eid Coelho, Arthur Accioly Rosa, Naomi Jay, Alexcia Camila Braun, Rodrigo Pinheiro, Héber Salvador
Journal of Surgical Oncology.2024; 130(4): 810. CrossRef
Improving R0 Resection Rates With a Posterior-First, 2-Stage Approach for En Bloc Resection of Locally Advanced Primary and Recurrent Anorectal Cancers Involving the Deep Pelvic Sidewall
Shinichiro Sakata, S. Mohammed Karim, Jorys Martinez-Jorge, David W. Larson, Kellie L. Mathis, Scott R. Kelley, Peter S. Rose, Eric J. Dozois
Diseases of the Colon & Rectum.2024; 67(1): 90. CrossRef
Oncologic Outcomes of Salvage Abdominoperineal Resection for Anal Squamous Cell Carcinoma Initially Managed with Chemoradiation
Roni Rosen, Felipe F. Quezada-Diaz, Mithat Gönen, Georgios Karagkounis, Maria Widmar, Iris H. Wei, J. Joshua Smith, Garrett M. Nash, Martin R. Weiser, Philip B. Paty, Andrea Cercek, Paul B. Romesser, Francisco Sanchez-Vega, Mohammad Adileh, Diana Roth O’B
Journal of Clinical Medicine.2024; 13(8): 2156. CrossRef
Anal carcinoma - exploring the epidemiology, risk factors, pathophysiology, diagnosis, and treatment
Kevan J English
World Journal of Experimental Medicine.2024;[Epub] CrossRef
A systematic review on the role of interventional radiotherapy for treatment of anal squamous cell cancer: multimodal and multidisciplinary therapeutic approach
Maria Concetta Campisi, Valentina Lancellotta, Bruno Fionda, Martina De Angeli, Stefania Manfrida, Patrizia Cornacchione, Gabriella Macchia, Alessio Giuseppe Morganti, Gian Carlo Mattiucci, Maria Antonietta Gambacorta, Roberto Iezzi, Luca Tagliaferri
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SURVIVAL AND PROGNOSTIC FACTORS OF ANAL CANCER: A STUDY BASED ON DATA FROM THE HOSPITAL-BASED CANCER REGISTRY OF A HIGH-COMPLEXITY ONCOLOGY CARE CENTER
Wallace Henrique Pinho da PAIXÃO, Gelcio Luiz Quintella MENDES, Débora Santos da SILVA, Rosyane Garcês Moreira Lima de SOUZA, Rodrigo Otavio de Castro ARAUJO, Karina Cardoso MEIRA, Rafael Tavares JOMAR
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Comparison of Perineal Closure Techniques after Abdominoperineal Resections for Carcinoma of the Anus
Jose L. Cataneo, Sydney A. Mathis, Sabreen Faqihi, Diana D. del Valle, Alejandra M. Perez-Tamayo, Anders F. Mellgren, Lee W. T. Alkureishi, Gerald GanttJr
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Follow-up imaging of anal cancer after treatment
Maria El Homsi, Shannon P. Sheedy, Gaiane M. Rauch, Dhakshina M. Ganeshan, Randy D. Ernst, Jennifer S. Golia Pernicka
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Survival outcomes following salvage abdominoperineal resection for recurrent and persistent anal squamous cell carcinoma
Daichi Kitaguchi, Yuichiro Tsukada, Masaaki Ito, Satoshi Horasawa, Hideaki Bando, Takayuki Yoshino, Kazutaka Yamada, Yoichi Ajioka, Kenichi Sugihara
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Risk factors and outcome following salvage surgery for squamous cell carcinoma of the anus
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Prognostic Value of Fusobacterium nucleatum after Abdominoperineal Resection for Anal Squamous Cell Carcinoma
Marc Hilmi, Cindy Neuzillet, Jérémie H. Lefèvre, Magali Svrcek, Sophie Vacher, Leonor Benhaim, Peggy Dartigues, Emmanuelle Samalin, Julien Lazartigues, Jean-François Emile, Eugénie Rigault, Nathalie Rioux-Leclercq, Christelle de La Fouchardière, David Tou
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Failure of Initial Curative Treatment for Non-Metastatic Anal Squamous Cell Carcinoma: From Prognostic Factors Analysis to Stratified Treatment
Claire Jaraudias, Lucile Montagneb Angélique Saint, Renaud Schiappa, David Baron, Léa Marie, Karen Benezery, Cyrielle Scouarnec, Éric François, Ludovic Evesque
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Rekonstruktion onkologischer Defekte der Perianalregion
Raymund E. Horch, Ingo Ludolph, Andreas Arkudas
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Original Articles

The Prognosis of Anal Cancer According to the Modality of Therapy.: Lee, Soon , Joo, Jai Kyun , Ryu, Seong Yeob , Kim, Hyeong Rok , Kim, Dong Yi , Kim, Young Jin; J Korean Soc Coloproctol. 2003;19(3):152-156.

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Abstract PDF: PURPOSE
Anal cancer is a relatively uncommon malignancy, representig only 1.8 to 3.4% of all colorectal cancers. In the past, an abdominoperineal resection (APR) was the treatment of choice for an anal cancer. Since the introduction of chemoradiation (radiation combined with 5-Fu and mitomycin) therapy which proved to enhance the responsiveness of the lesion, the limited resection with preservation of anal sphincter function became the gold standard treatment of the anal lesion. Few studies have examined the effectiveness of each modality due to the rarity of this disease. We compared the results of treatment in two groups, one treated with APR and the other with chemoradiation, and evaluated the prognosis of the anal cancer and the advantages and disadvantages of each method.
METHODS
This study was performed from January 1992 to December 2001 in the Department of Surgery, Chonnam University Hospital. It considered many factors, including sex, age, chief complaint, location of the lesion, size of the lesion, histopathologic pattern, method of treatment, and metastasis, based on a retrospective review of clinical files and biopsy results.
RESULTS
For the patients, the male to female ratio was 1.8:1.0; the mean age was 64.6 (47~90); the chief complaint was anal mass; with symptoms of anal bleeding and pain; and the mean prevalence rate of disease was 8.5 months. According to the staging, 4 patients were T1 (14%), 19 (67.8%) were T2 and 4 (14.3%) were T3. By histologic biopsy, there were 23 squamous cell and 5 cloacogenic carcinoma. Four patients were initially treated by an APR at a local clinic, while 22 underwent combined chemoradiation therapy. Of the four patients who underwent a chemoradiation after an APR, two died as a result of liver and bone metastasis. According to the TNM classification, the 5-year survival rates were 75, 67, 60, 83, and 55% for T1, T2, T3, M0, M1, respectively; the 5-year survival was 71% the for combined chemotherapy and radiation and 53% for the APR.
CONCLUSIONS
In the anal cancer treatment, remission occured in over 50% of patients treated with combined chemoradiation therapy. Also, when the surgery had added, the prognosis was not worse than primary choice of APR. Therefore, combined chemoradiation therapy should be considered the treatment of choice, reducing the amount of resection and conserving the sphincter function.

The Clinical Features and Charateristics of anal Cancer Arising from Chronic Fistula-in-ano.: Son, Byung Ho , Han, Won Kon , Kim, Heung Dae , Kim, Kwang Yun; J Korean Soc Coloproctol. 2002;18(6):373-378.

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Abstract PDF: PURPOSE
The incidence of unhealed chronic fistula is about 7% and the cancer can occur in the longstanding unhealed fistula. The most of the cancer is mucinous adenocarcinoma. The report is diverse about treatment, adjuvant chemotherapy and prognosis. The purpose of this study is review of the clinical characteristics and survival of the anal cancer arising from chronic fistula-in-ano.
METHODS
The number of patients was 10. The diagnosis is made under pathological examination at the Kanbuk Samsung Hospital from 1983 to 2000. The retrograde study was done with patients' records and telephone questionnaire. The survival rate was calculated with Kaplan-Meier method.
RESULTS
All patients were male. The patients had symptoms of anal discharge and anal swelling suggesting the anal fistula. The patients had history of anal surgery. The external openings were multiple. Seven patients had mucinous adenocarcinoma. The prognosis was poor. Among 8 patients' follow-up data, except one patient, 7 patients died within 43 months.
CONCLUSIONS
The anal cancer can occur in longstanding unhealed fistula. In our series, all patients were male, and they had multiple opening fistula. The patient who had small size tumor have only survived. Through meticulous exploring and deep biopsy of the fistula, early detection is best method to treat the anal cancer arising from chronic fistula-in-ano.

Malignant Tumors of the Anus: Spectrum of Disease, Treatment and Outcomes.: Huh, Kyu Ha , Lee, Kang Young , Ha, Hyun Soo , Park, Jae Kun , Kim, Nam Kyu , Sohn, Seung Kook , Min, Jin Sik; J Korean Soc Coloproctol. 2002;18(5):337-342.

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Abstract PDF: PURPOSE
This retrospective study was performed to evaluate clinicopathologic findings, outcomes according to the treatment modality, and prognostic factors in anal cancer.
METHODS
Among the 64 patients who were diagnosed as anal cancer at our department from September 1986 to December 1999, 55 patients were analysed retrospectively. Nine patients who refused the treatment or whose medical record could not be retrieved were excluded. Concurrent chemoradiotherapy was performed for twenty-seven patients with squamous cell carcinoma. The chemotherapy with 5-FU and cisplatin and the radiotherapy were started at the same time. 750 mg/m2/day of 5-FU was infused intravenously for 5 days and 100 mg/m2 of cisplatin was started on the second day of therapy. The second cycle chemotherapy was given for 5 days before the radiotherapy was completed. A dose of 5,400cGy was given to the primary lesion and whole pelvis including inguinal area. Eight patients with squamous cell carcinoma were treated by surgery including abdominoperineal resection, local excision, or wide excision. Abdominoperineal resection was the primary treatment modality for melanoma of anus.
RESULTS
Among 55 patients with anal cancer, the dominant histologic type was squamous carcinoma (n=35), followed by cloacogenic carcinoma (n=6) and melanoma (n=6). The clinical stages by AJCC were classified as stage I: 4 cases, stage II: 15 cases, stage III: 29 cases, stage IV: 7 cases. The overall 5-year survival rate of anal cancer was 60%. The 5-year survival rate in squamous carcinoma was 79.9% for the concurrent chemoradiotherapy group (n=27) and 54.7% for the surgical resection group (n=8), which was statistically insignificant. Variables affecting the survival rate with statistical significance were age, the initial tumor size, and the state of lymph node and distant metastasis.
CONCLUSIONS
The concurrent chemoradiotherapy for patients with squamous cell carcinoma of the anus offered the same outcomes equivalent to surgical modality and preserved anal sphincter function. Melanoma of the anus exhibited poor prognosis and more systemic recurrence regardless of treatment modality. On univariate analysis for risk factors, age, tumor size, and lymph node and distant metastasis had statistical significance.

33 Cases of Anal Cancer.: Ahn, Byung Kwon , Park, Yong Rae , Baek, Sung Uhn; J Korean Soc Coloproctol. 1998;14(4):743-750.

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Abstract PDF: PURPOSE
Malignant disease of the anus is rare. Abdominoperineal resection was formerly considered to be the treatment of choice. But, in recent, less ablative and more effective combined therapeutic modalities have been developed.
METHODS
we analyzed 33 patients who were diagnosed and treated as anal cancers at the Department of Surgery, Gospel Hospital, Kosin Medical Collage, from July 1, 1988 to Nov. 30, 1997.
RESULTS
The ratio of male to female was 1.4:1 and mean age was 56.7 years old. Twenty-two (84.8%) of these cancers were located in the anal canal and 5 (15.2%) in the anal margin. Three main histologic types of the anal cancers were identified: squamous cell carcinoma was the most common lesion, accounted for 17 cases (51.1%), adenocarcinoma accounted for 8 cases (24.2%), malignant melanoma accounted for 8 cases (24.2%). The overall 3-year survival rate and 5-year survival rate of anal cancer were 54.1%, 41.7%. Eleven patients with squamous cell carcinoma were treated curatively: 6 patients were treated with chemoradiotherapy, 3 patients with abdominoperineal resection, one patient with chemoradiotherapy and abdominoperineal resection, one patient with local excision.
CONCLUSION
In survival rate, there were no significant differences between chemoradiotherapy group and surgical treatment group. In squamous cell carcinomas, chemoradiotherapy had anal sparing benefit without loss of survival. On univariate analysis, T, N, type of treatment, histologic type had no statistical significances on survival. On multivariate analysis, location of lesion and distant metastasis had statistical significances.

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