Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer

Br J Surg. 2005 May;92(5):605-14. doi: 10.1002/bjs.4908.


Background: Salvage surgery for anal cancer is usually reserved for local disease failure, but issues relating to the prediction of local failure and surgical outcome are ill defined.

Methods: Between 1988 and 2000, 254 patients with non-metastatic anal epidermoid carcinoma were treated at a regional cancer centre with radiotherapy (n = 127) or chemoradiotherapy (n = 127).

Results: There were 99 local disease failures (39.0 per cent), all but five occurring within 3 years of initial treatment. Increasing age (P < 0.001, Cox model), total radiation dose (P = 0.004) and tumour stage (P = 0.010) were independent predictors of local failure. The overall 3- and 5-year survival rates after local disease failure were 46 and 29 per cent; the corresponding rates after salvage surgery (73 patients) were 55 and 40 per cent. A positive resection margin was the strongest negative predictor of survival after salvage surgery (P = 0.008, log rank test). Of 52 patients treated before the routine consideration of primary plastic reconstruction, delayed perineal wound healing occurred in 22 (42 per cent).

Conclusion: In the management of anal cancer, local disease failure is a major clinical problem requiring early detection followed by radical surgery, often accompanied by plastic reconstruction. By implication, these factors favour the centralization of treatment for this uncommon cancer to a multidisciplinary oncology team.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anus Neoplasms / drug therapy
  • Anus Neoplasms / radiotherapy
  • Anus Neoplasms / surgery*
  • Carcinoma, Squamous Cell / drug therapy
  • Carcinoma, Squamous Cell / radiotherapy
  • Carcinoma, Squamous Cell / surgery*
  • Colostomy / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neoplasm, Residual
  • Postoperative Complications / etiology
  • Proportional Hazards Models
  • Prospective Studies
  • Salvage Therapy / methods*
  • Survival Analysis
  • Treatment Failure
  • Treatment Outcome