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
La radiologia medica.2024; 129(12): 1739. CrossRef
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
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2024;[Epub] CrossRef
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
The American Surgeon™.2023; 89(2): 238. CrossRef
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
European Journal of Surgical Oncology.2023; 49(9): 106929. CrossRef
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
European Journal of Surgical Oncology.2023; 49(10): 107050. CrossRef
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
Diseases of the Colon & Rectum.2023; 66(11): 1427. CrossRef
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
Cancers.2022; 14(7): 1606. CrossRef
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
Der Chirurg.2021; 92(12): 1159. CrossRef
Rekonstruktion onkologischer Defekte der Perianalregion
Raymund E. Horch, Ingo Ludolph, Andreas Arkudas
coloproctology.2021; 43(6): 431. CrossRef

Original Article

Chemotherapeutic Response and Survival for Patients With an Anal Squamous Cell Carcinoma and Low Hemoglobin Levels: Ali Zain Naqvi, Esther Platt, Maki Jitsumura, Martyn Evans, Mark Coleman, Sebastian Smolarek; Ann Coloproctol. 2018;34(6):312-316. Published online December 31, 2018; DOI: https://doi.org/10.3393/ac.2017.10.12

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1 Web of Science
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Abstract PDF

Purpose
Anemia is associated with poor treatment results for a variety of cancers. The effect of low hemoglobin levels on long-term outcomes after the treatment of patients with an anal squamous cell carcinoma (SCC) remains unclear. For that reason, this study aimed to investigate the effect of anemia on treatment outcomes following chemoradiation for an anal SCC.
Methods
This was a retrospective study of all patients who underwent curative treatment for an anal SCC between 2009 and 2015 at 2 trusts in the United Kingdom. Data were collated from prospectively collected cancer databases and were cross-checked with operating-room records and records in the hospitals’ patient management systems.
Results
We identified 103 patients with a median age of 63 years (range, 36–84 years). The median overall survival was 39 months (range, 9–90 months), and the disease-free survival was 36 months (range, 2–90 months). During the follow-up period, 16.5% patients died and 13.6% patients developed recurrence. Twenty-two people were anemic prior to treatment, with a female preponderance (20 of 22). No differences in disease-free survival (P = 0.74) and overall survival (P = 0.12) were noted between patients with anemia and those with normal hemoglobin levels. On regression the analysis, the combination of anemia, the presence of a defunctioning colostomy, lymph-node involvement and higher tumor stage correlated with poor overall survival.
Conclusion
In this study, anemia did not influence disease-free survival or overall survival. We suggest that the interaction between anemia and survival is more complex than previously demonstrated and potentially reliant on other coexisting factors.

Citations

Citations to this article as recorded by

Prognostic and Predictive Clinical and Biological Factors in HPV Malignancies
Shivani Sud, Ashley A. Weiner, Andrew Z. Wang, Gaorav P. Gupta, Colette J. Shen
Seminars in Radiation Oncology.2021; 31(4): 309. CrossRef

Case Report

Efficacy of Immunohistochemical Staining in Differentiating a Squamous Cell Carcinoma in Poorly Differentiated Rectal Cancer: Two Case Reports: Sairafi Rami, Yoon Dae Han, Mi Jang, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim; Ann Coloproctol. 2016;32(4):150-155. Published online August 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.4.150

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Abstract PDF: A rectal carcinoma, including primary an adenosquamous and a squamous cell carcinoma (SCC), is a very rare disease, accounting for 0.025% to 0.20% of all large-bowel malignant tumors. Because SCCs have a higher mortality than adenosquamous carcinomas, determining whether the primary rectal cancer exhibits an adenomatous component or a squamous component is important. While differentiating between these 2 components, especially in poorly differentiated rectal cancer, is difficult, specific immunohistochemical stains enable accurate diagnoses. Here, we report the use of immunohistochemical stains to distinguish between the adenomatous and the squamous components in 2 patients with low rectal cancer, a 58-year-old man and a 73-year-old woman, who were initially diagnosed using the histopathologic results for a poorly differentiated carcinoma. These data suggest that using these immunohistochemical stains will help to accurately diagnose the type of rectal cancer, especially for poorly differentiated carcinomas, and will provide important information to determine the proper treatment for the patient.

Original Article

Malignancy Associated with Inflammatory Bowel Disease.: Shin, Ui Sup , Yu, Chang Sik , Kim, Chan Wook , Park, Jin Seok , Jeong, Kwang Yong , Yoon, Sang Nam , Lim, Seok Byung , Song, Joon Seon , Kim, Jin Cheon; J Korean Soc Coloproctol. 2009;25(3):150-156.; DOI: https://doi.org/10.3393/jksc.2009.25.3.150

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5 Citations

Abstract PDF

PURPOSE
As the number of patients with inflammatory bowel disease (IBD) has steadily increased in Korea, IBD-associated cancers are expected to increase in number. This study investigated the clinical features of intestinal cancer in patients with IBD.
METHODS
One hundred five patients with ulcerative colitis (UC) and 270 patients with Crohn's disease (CD) under the care of the Department of Colon and Rectal Surgery, Asan Medical Center, between December 1989 and January 2009 were reviewed retrospectively.
RESULTS
Ten patients of the 105 with UC and 5 patients of the 270 with CD were found to have intestinal cancer. The mean age was 45 yr (+/-8.8), and the mean duration of IBD at the time of diagnosis of the cancer was 12.6 yr (+/-6.0). Six of the 15 cancer patients had no history of treatment for IBD of more than 3 mo before diagnosis of the cancer. Eleven cancers were located in the rectum (7 in UC, 4 in CD), including 1 case of synchronous cancer. One case of small bowel cancer was found in a patient with small bowel CD. Four cases involved a mucinous adenocarcinoma. Eight of the 12 cases of an adenocarcinoma of the colon and rectum were advanced stage.
CONCLUSION
IBD-associated intestinal cancers were found at a relatively young age, were diagnosed at an advanced stage, and had a higher proportion of mucinous adenocarcinomas than in sporadic cancer. Considering the increasing incidence of IBD and the expected increase in the number of IBD-associated cancer in Korea, every effort should be made to prevent intestinal cancer in patients with IBD and to detect it early.

Citations

Citations to this article as recorded by

Rectal Squamous Cell Carcinoma in a Patient with Familial Adenomatous Polyposis
Hye Min Jo, Hyun Jung Kim, Jina Youn, Seong Kyu Park, Dae Sik Hong, A Reum Chun, Hee Kyung Kim
Korean Journal of Medicine.2015; 88(3): 335. CrossRef
Primary Squamous Cell Carcinoma of the Ascending Colon: Report of a Case and Korean Literature Review
Dong-Keun Cho, Sang-Hun Kim, Sung-Bum Cho, Wan-Sik Lee, Young-Eun Joo
The Korean Journal of Gastroenterology.2014; 64(2): 98. CrossRef
Clinical Characteristics of Lower Gastrointestinal Cancer in Crohn's Disease: Case Series of 5 Patients
Ji Min Choi, Changhyun Lee, Yoo Min Han, Minjong Lee, Dong Kee Jang, Jeehye Kwon, Jong Pil Im, Sang Gyun Kim, Joo Sung Kim, Hyun Chae Jung
Intestinal Research.2013; 11(2): 127. CrossRef
A Case of Squamous Cell Carcinoma of the Breast in a Patient with Crohn's Disease Taking Azathioprine
Kyoung Chan Park, Dong Uk Ju, Seong Wook Heo, Jung Il Ryu, Ju Youn Cho, Eui Jung Kim, Hoon Kyu Oh, Eun Young Kim
The Korean Journal of Gastroenterology.2012; 60(6): 373. CrossRef
Squamous Cell Carcinoma of the Rectum: Report of Two Cases
Na Rae Kim, Dong Hae Chung, Jeong Heum Baek, Yeon Ho Park, Hee Eun Kyung, Mi Sook Roh, Seung-Yeon Ha
Intestinal Research.2010; 8(2): 172. CrossRef

Case Reports

Double Primary Cancer Patient with Sigmoid Colon Adenocarcinoma and Anal Squamous Cell Carcinoma with Rectal Mucosal Metastasis A case report.: Rhyou, Jai Hyun , Shim, Kang Sup , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 1998;14(3):629-634.

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Abstract PDF: Synchronous neoplams are uncommon condition but the incidence is now being increased. The situation is rare when these tumors comes from different origin. We experienced the case with synchronous sigmoid colon cancer and anal squamous cell carcinoma with rectal mucosal metastasis. The patient was 61 years old male. He complained of intermittent hematochezia since 3~4 months ago. The patient underwent anterior resection for colon cancer and wide excision for anal squamous cell carcinoma. After surgical operation, postoperative adjuvant chemotherapy (5-FU + Leucovorin) and radiotherapy were done. In this case, we could preserve the anal sphincter using combined therapy. We think that this type of management may be useful treatment in patients with colon cancer and anal squamous cell cancer simultaneously.

A Case of Squamous Cell Carcinoma Arising in the Mature Cystic Teratoma with Direct Invasion to Transverse Colon and Jejunum.: Lee, Do Sang , Song, Moo Hyung , Kim, Wook , Park, Il Young , Won, Jong Man; J Korean Soc Coloproctol. 1998;14(1):149-152.

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Abstract PDF: Malignant degeneration of mature cystic teratoma has been reported in 1~3% of cases, usually between the age of 30 and 70 years with a peak incidence of 40~60 years. The most common malignancy developing in such tumors is squamous cell carcinoma arising in a mature cystic teratoma. Hirakawa reported two patients with benign teratomas diagnosed 25 and 32 years prior to surgery for malignancy and Dorothea reported a patient who was diagnosed as benign teratoma 50 years prior to operate for carcinoma. But there has been no report of squamous cell carcinoma arising in the mature cystic teratoma with direct invasion to gastrointestinal tract. We report a case of squamous cell carcinoma with direct invasion to transverse colon and jejunum in 62-year-old female who was diagnosed as mature cystic teratoma 20 years ago.

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