Survival and Operative Outcomes After Salvage Surgery for Recurrent or Persistent Anal Cancer

Abstract

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.

Keywords: Anal cancer; Persistent; Recurrent; Salvage; Squamous cell.

Fig. 1.

Locally recurrent anal cancer. (A) Computed tomography scan showing recurrent anal carcinoma invading levator muscle (yellow arrow). (B) Magnetic resonance imaging (MRI) demonstrating recurrent mass within pelvic cavity. (C) MRI shows mass invading pelvic floor (white arrow) and invading outside the pelvis into subgluteal plane (yellow arrow). (D) MRI sagittal view shows invasion into perianal soft tissue.

Fig. 2.

Variable location of inguinal lymph node metastasis in patients with anal cancer identified in positron emission tomography-computed tomography (PET-CT) scan. (A, B) The cross-sectional PET-CT scans noted both inguinal (yellow arrow), external iliac (red arrow), and lateral pelvic (yellow dotted arrow) lymph nodes. (C) The longitudinal PET-CT scan identifying inguinal (yellow arrow), external iliac (red arrow), and perirectal (red dotted arrow) lymph nodes.