Salvage Surgery for Locoregional Failure in Anal Squamous Cell Carcinoma

Guerra, Glen R; Kong, Joseph C; Bernardi, Maria-Pia; Ramsay, Robert G.; Phillips, Wayne A.; Warrier, Satish; Lynch, A. C.; Ngan, Samuel Y; Heriot, Alexander G.

doi:10.1097/dcr.0000000000001010

Cited by 18 publications

(24 citation statements)

References 34 publications

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“…A recent Australian study by Guerra et al . reported 5‐year overall survival rates following salvage APR for anal SCC of 51% with positive margins being predictive of future relapse . This is supported by findings of previous studies and raises the possibility of improving treatment by enlarging resection margins to achieve R0 resection .…”

Section: Discussionsupporting

confidence: 74%

Anal squamous cell carcinoma: are we improving outcomes?

Mackowski

Levitt

Makin

et al. 2018

ANZ Journal of Surgery

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Section: Discussionsupporting

confidence: 74%

Anal squamous cell carcinoma: are we improving outcomes?

Mackowski

Levitt

Makin

et al. 2018

ANZ Journal of Surgery

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“…In this large database study, early vs late salvage APR does not predict overall survival. Despite our findings, many studies still report that the overall survival remains as low as 30% when there is persistent or recurrent disease . In our study, as others have done, we identified additional independent predictors of survival.…”

Section: Discussioncontrasting

confidence: 61%

“…Following salvage APR, 5‐year survival rates range from 30% to 78% . Hence, it is important to determine the factors influencing prognosis following salvage surgery.…”

Section: Introductionmentioning

confidence: 99%

Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

Fields

Melnitchouk

Senturk

et al. 2019

Journal of Surgical Oncology

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Background/Objectives The first‐line treatment for anal squamous cell carcinoma is Nigro protocol chemoradiotherapy. Some patients will fail curative intent chemoradiotherapy and have persistent disease while others may have an initial response followed by disease recurrence. The goal of this study is to investigate survival in anal squamous cell carcinoma patients who fail first‐line treatment. Methods The National Cancer Database (2004‐2013) was used to identify patients with anal squamous cell carcinoma. The primary outcome was overall survival. Results There were 256 patients in the early salvage group who underwent abdominoperineal resection (APR) within 6 months of completing chemoradiotherapy and 181 patients in the late salvage group who had APR 6 months or more after completion of chemoradiotherapy. Both groups of patients had similar tumor size (45 vs 50 mm; P = 0.07) and rate of positive margins (21.5% vs 15.6%;P = 0.13). There was no significant difference in overall survival between early and late salvage APR (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.50‐1.32; P = 0.40). Conclusions The overall survival of anal squamous cell carcinoma patients undergoing early vs late salvage APR after failure of chemoradiotherapy is similar. As a result, patients with persistent disease should be offered surgery just as readily as those with recurrent disease.

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“…Of these, 21 studies met our predefined eligibility criteria and were included in this systematic review [8][9][10][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. The repeat search revealed an additional 28 citations and they were also included in the review [31][32][33][34][35]. The flowchart summarizing the systematic search strategy is given in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…There were two studies in which all patients received 5-fluorouracil (5-FU) with mitomycin C (MMC) [18,22] and one study in which all patients received 5-FU with cisplatin [19]. Seventeen studies had patients who received a combination of 5-FU, MMC and cisplatin [8,9,13,14,16,17,20,21,23,24,27,[30][31][32][33][34]37]. Patients were treated primarily with bleomycin or carboplatin with 5-FU in one study [25].…”

Section: Chemoradiation Therapy Protocolsmentioning

confidence: 99%

A systematic review of outcomes after salvage abdominoperineal resection for persistent or recurrent anal squamous cell cancer

Sarkaria

Merchant

et al. 2019

Colorectal Disease

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Aim Up to 30% of patients with squamous cell cancer of the anus (SCCA) will require a salvage abdominoperineal resection (APR) for either persistent or recurrent disease. The objective of this study was to assess cancer‐related outcomes in patients with (i) persistent or (ii) recurrent SCCA. Method Embase and MEDLINE were searched. Publications were included if they assessed overall survival (OS), disease‐free survival (DFS) and locoregional recurrence or metastatic disease after salvage APR for persistent or recurrent SCCA. Results A total of 28 retrospective case series (study size ranged from nine to 111) met our inclusion criteria. The median time to salvage APR was 2.6 months [interquartile range (IQR) 2.6–5.0 months, six studies] for persistent disease and 27.6 months (IQR 15.0–32.7 months, five studies) for recurrent disease. The median 5‐year OS from the time of salvage APR was 45.0% (IQR 32.0%–52.3%, 10 studies) for persistent disease and 51.0% (IQR 36.0%–60.9%, 11 studies) for recurrent disease. The median 5‐year DFS following salvage APR was 44.0% (IQR 29.5%–53.0%, 10 studies) for all patients. Following salvage APR, the median locoregional recurrence rate was 23.5% (IQR 15.8%– 46.9%, 19 studies) and 9.0% (IQR 6.4%–13.3%, 16 studies) of patients developed metastatic disease after salvage APR. Conclusion Our review characterizes the best evidence for outcomes following salvage APR for patients with persistent or recurrent SCCA. The evidence is limited by the quality of included studies, as many were single centre case series.

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Salvage Surgery for Locoregional Failure in Anal Squamous Cell Carcinoma

Abstract: Advanced T stage is an independent predictor of local failure in anal squamous cell carcinoma. Most patients can be salvaged, with a positive resection margin being a strong predictor of further relapse and poor outcome. See Video Abstract at http://links.lww.com/DCR/A515.

Cited by 18 publications

References 34 publications

Anal squamous cell carcinoma: are we improving outcomes?

Anal squamous cell carcinoma: are we improving outcomes?

Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

A systematic review of outcomes after salvage abdominoperineal resection for persistent or recurrent anal squamous cell cancer

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