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
Abdominal Radiology.2023; 48(9): 2888. CrossRef
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
Julie Borg, Karen-Lise Garm Spindler, Birgitte Mayland Havelund, Mette Møller Sørensen, Jonas Amstrup Funder
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Pelvic Exenteration for Squamous Cell Carcinoma of the Anus: Oncological, Morbidity, and Quality-of-Life Outcomes
Kilian G.M. Brown, Michael J. Solomon, Daniel Steffens, Kheng-Seong Ng, Christopher M. Byrne, Kirk K.S. Austin, Peter J. Lee
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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
Clinical Colorectal Cancer.2022; 21(4): 362. CrossRef
Rekonstruktion onkologischer Defekte der Perianalregion
Raymund E. Horch, Ingo Ludolph, Andreas Arkudas
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Rekonstruktion onkologischer Defekte der Perianalregion
Raymund E. Horch, Ingo Ludolph, Andreas Arkudas
coloproctology.2021; 43(6): 431. CrossRef

Case Report

The Rectus Abdominis Myocutaneous Flap for the Immediate Reconstruction of Partial Vaginal Defects Following the Extended Abdominoperineal Resection of Recurrent Rectal Cancer.: Lee, Suk Hwan , Yoo, Young Chun; J Korean Soc Coloproctol. 2006;22(3):210-213.

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Abstract PDF: Extensive resection including posterior vaginal wall may be required for the advanced low rectal cancer or recurrent rectal cancer in order to achieve the tumor free circumferential margins. We describe closure of a vaginal defect with rectus abdominis musculocutaneous flap after extended abdominoperineal resection, hysterectomy and partial colpectomy in a patient with recurrent rectal cancer with the special reference to the surgical technique.

Original Articles

Pelvic Exenteration as the Treatment for Recurrent or Locally Advanced Rectal Cancer.: Song, Seong Kyu , Park, Yong Keun , Suh, Kwang Wook; J Korean Soc Coloproctol. 2005;21(5):314-319.

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Abstract PDF: PURPOSE
The purpose of this study is to evaluate the value of pelvic exenteration (PE) for recurrent or locally advanced rectal cancer.
METHODS
This retrospective study analyzed 20 patients who underwent PE for rectal cancer from June 1994 to October 2003 in Ajou University Hospital. The surgical severity, the postoperative complications, and the survival rate were analyed based on the medical records.
RESULTS
The mean operation time was 221.5+/-93.0 minutes, the mean blood loss 750.5+/-223.3 cc, and the mean transfusion amount RBC 6.5+/-4.3 units. Operative mortality was 5% (1/20). A bleeding-associated complication was noted in one patient who underwent a reoperation for hemostasis. Other minor complications were small bowel obstruction (n=3), abdominal wound infection (n=5), vesicocutaneous fistula (n=2), delayed healing of the perineal wound (n=10). The overall 5-year survival rate was 52.6% (10 of 19 patients, excluding the operative mortality case).
CONCLUSIONS
Our study showed acceptable surgical severity and postoperative complications and a favorable 5-year survival rate (> or =50%) for pelvic exenteration as a treatment for recurrent or locally advanced rectal cancer. With strictly selected patients, PE may be one of the treatment options for recurrent or locally advanced rectal cancer.

Surgical Treatment of Recurrent Colorectal Cancer.: Koo, Gwang Mo , Park, Sang Su , Yoon, Jin , Kim, Il Myoung , Yu, Byoung Uk , Yang, Dae Hyun , Cho, Ik Hang; J Korean Soc Coloproctol. 2003;19(5):314-321.

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Abstract PDF: PURPOSE
Recurrent colorectal cancers have important and difficult diagnostic and treatment problems. The purpose of this study is to evaluate the rationale and the efficacy of surgical re-treatment for patients with recurrence following curative surgery for colorectal cancer.
METHODS
From January 1991 to December 2002, we experienced 60 (20.9%) patients with recurred colorectal cancer among 287 patients who had curative operations in our hospital. These 60 patients were divided into three groups. Patients in group 1 had curative-intent resections, patients in group 2 had palliative resections, and patients in group 3 had conservertive treatment. The groups consisted of 17 (28.3%), 10 (16.7%) and 33 (55.0%) patients, respectively. We analyzed retrospectively those groups for any recurrence pattern and for survival.
RESULTS
Of the 60 patients with recurrent colorectal cancer, in 20 (33.3%) patients the cancer recurred in the colon, and in 40 (66.7%) it recurred in the rectum. Local recurrence was seen in 9 (15.0%) patients, liver metastasis in 25 (41.7%), and pulmonary metastasis in 13 (21.7%). The 1- and 3-, and 5-year survival rates were 86.5%, 31.7%, and 15.9%, respectively, for group 1, 33.3%, 0%, and 0% for group 2, and 28.9%, 4.4%, and 4.4% for group 3. The median survival period was 31 months for group 1, 8 months for group 2, and 7 months for group 3.
CONCLUSIONS
Although evaluation was difficult owing to the small number of patients with recurrent colorectal cancer, a significant difference in survival rates was observed between the treatment groups. On the basis of these results, we think that curative-intent aggressive surgery for recurrent colorectal cancer in appropriately selected cases can clearly prolong survival when compared with palliative resections and conservative treatment.

Case Reports

Papillary Serous Carcinoma in Rectum-a Case of Complete Remission of Bulky Pelvic Disease after Platinum-paclitaxel Combination Chemotherapy.: Choi, Jung Hun , Yoon, Suk Hyun , Yoon, Wan Hee; J Korean Soc Coloproctol. 2002;18(6):419-422.

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Abstract PDF: Papillary serous carcinoma of the peritoneum (PSCP) is a primary tumor of peritoneal lining (mesothelioma) of the abdomen and is histologically difficult to differentiate from papillary serous carcinoma of the ovary. It is very rare tumor that involves the surface of the pelvic and/or abdominal peritoneum. Most patients with this tumor have been treated with optimally surgical cytoreduction and postoperative chemotherapy. However, long term survival has not been achieved in many studies. In recent years, platinum-paclitaxel combination therapy was reported as a effective initial therapy for recurrent PSCP. We have experienced one case of recurrent PSCP which was successfully treated with heptaplatin and paclitaxel. We report the toxicity and long term result of the patient.

A Case of Recurrent Perianal Paget's Disease.: Bang, Sang Young , Kang, Won Kyung , Park, Jong Kyung , Kim, Ji Yeon , Park, Seung Chul , Ahn, Chang Hyuk , Oh, Seong Taek; J Korean Soc Coloproctol. 2001;17(6):346-349.

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Abstract PDF: Extramammary Paget's disease is an uncommon intraepithelial carcinoma of the skin and mucosa usually occurring in the anogenital area. Perianal Paget's disease is a rare entity, often associated with internal malignancies and a poor prognosis. Clinical manifestations of perianal Paget's disease include pruritis (most common), irritation, rash, lump sensation and the lesion shows erythematous, crusted or scaly area which may weep clear fluid. Lichenified, leukokeratotic or leukoplakia-like patches may also develop in some patients. These areas may resemble eczema or contact dermatitis. Many authors recommend surgery as the treatment of choice. Extended surgical excision for non-invasive lesion and excision of rectum or abdominoperineal resection for invasive disease is recommended. The prognosis for non-invasive lesion is excellent, but for invasive lesion is poor.We experienced one case of perianal Paget's disease which recurred after wide excision of vulvar area for Paget's disase, and performed secondary abdominoperineal resection. Now, radiation therapy was done for adjuvant therapeutic modality.

Original Articles

A Combined Treatment of Tamoxifen, Goserelin, and Sulindac in 2 Cases of Recurrent Desmoid Tumor in the Abdomen.: Kim, Hee Cheol , Suh, Byung Sun , Lee, Dong Hee , Ahn, Byung Yool , Chung, Choon Sik , Kang, Gyeong hoon , Ha, Hyun Kwon , Kim, Jin Cheon; J Korean Soc Coloproctol. 1999;15(4):339-343.

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Abstract PDF: Desmoid tumor is a subtype of fibromatosis arising from deep fascial or soft tissue structure. It is characterized by locally aggressive behavior with a tendency to local recurrence, but is generally accepted the lack of ability for distant metastasis. Although excision is the best initial therapy, surgery is not always amenable in cases of lesions lying in difficult anatomical area. Two female patients with recurrent desmoid tumor in abdomen and pelvis after excision were treated with tamoxifen, goserelin, and sulindac. This therapy led to a progressive decrease of tumor size within 13 months in one patient. However, in the other patient, this combined therapy failed to reduce the size of the tumor. Despite the success of combined therapy with hormone and nonsteroidal anti-inflammatory drug is anecdotal, this treatment may improve the survival and reduce the recurrence in certain sub-group of desmoid tumor.

Treatment of the Recurrent Hemorrhoids.: Kim, Yeon Dae , Lee, Dong Hee , Kim, Hee Cheol , Jeong, Choon Sik , Kim, Chang Nam , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 1998;14(3):503-508.

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Abstract PDF: The incidence of recurrence and anal stricture after surgical hemorrhoidectomy were reported in about 5% and 2.5~13%, respectively Generally, complete and adequate surgery for hemorrhoids was not infrequently neglected because the treatment of hemorrhoids was based on symptoms rather than pathogenesis. This study was performed to analyze the clinical features of recurrent hemorrhoids and to assess the adequate surgical management for the prevention of recurrence. From June 1989 to December 1997, we reviewed 222 (10.6%) recurrent hemorrhoids of surgically treated at Asan Medical Center. Median follow-up period was 38 months (range, 4 months~8 years 9 months). The most common symptom was prolapse (37%). Previous treatment for hemorrhoids was surgical hemouhoidectorny in 99 cases (45%) and sclerotherapy in 111 cases (50%). The most common location and associated complication of recurrent hemorrhoids were sites of major piles (83%) and anal stricture (37%), respectively. Anal stricture was more prevalent in patients with previous sclerotherapy (P<0.05). In respect to the numbers of combined surgical procedures, one procedure was more frequently performed in the non-complicated recurrent hemorrhoids group (P<0.05) whereas over four in the complicated group (P<0.05). Internal sphincterotomy and anoplasty were frequently needed in the complicated recurrent hemorrhoids (P<0.05). Mean hospital stay and healing time were 5 days (range, 2~26 days) and 21 days (range, 6~180 days), respectively. We had excellent or satisfactory results in 175 of 197 patients (89%). Conclusively, multiple combined surgical procedures in accordance with individual status might be useful in treating the recurrent hemorrhoids. An adequate and complete surgical procedure must be applied during the initial operation of hemorrhoids, especially on major piles.

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