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Outcome following local excision of T1 anal cancers—a systematic review

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

In most cases, squamous cell carcinoma of the anus (SCCA) is treated with chemo-radiotherapy preserving sphincter function and offering good long-term survival and low recurrence rates. However, chemo-radiotherapy has several side effects: dyspareunia, impotence, fecal incontinence, pain, and skin symptoms. Small/T1 tumors, without metastatic disease, can be treated with local excision alone. We aimed to systematically review the literature regarding outcome following local excision of T1 SCCA.

Methods

PubMed and Embase databases were searched for studies that investigated outcome following local excision of SCCA.

Results

Twenty-three studies were included. Twenty of the studies were retrospective, and three studies included more than 100 patients. Most of the studies were published before the 1980s. Overall there was great heterogeneity and missing data across the included studies when comparing patient demographics, resection margins, definitions on tumor location, and outcome.

Overall 5-year survival was 69% (95% CI 66–72) following local excision. Overall 5-year recurrence was 37% (95% CI 30–45) following local excision. No complications were reported following local excision.

Conclusion

The current literature on outcome following local excision of T1 anal cancers consists predominantly of smaller, retrospective, and heterogenous studies. Overall 5-year survival is acceptable, but worse than following chemo-radiation therapy. However, local excision seems to have no or only few minor complications. Recurrence rates are high. Therefore, a thorough follow-up program is needed when performing local excision as primary treatment for T1 SCCA. There is an evident need for further studies.

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Authors and Affiliations

  1. Herlev Hospital, Herlev, Denmark

    T. B. Pedersen, J. Kildsig, E. Serup-Hansen, P. Gocht-Jensen & M. F. Klein

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  1. T. B. Pedersen
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  2. J. Kildsig
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  3. E. Serup-Hansen
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  4. P. Gocht-Jensen
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Contributions

Article idea: Torben Bridstrup Pedersen.

Literature search: Torben Bridstrup Pedersen and Jeppe Kildsig.

Data analysis: Torben Bridstrup Pedersen and Jeppe Kildsig.

First draft: Torben Bridstrup Pedersen.

Critical revision: Peter Gocht-Jensen, Eva Serup-Hansen, and Mads Falk Klein.

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Correspondence to T. B. Pedersen.

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Pedersen, T.B., Kildsig, J., Serup-Hansen, E. et al. Outcome following local excision of T1 anal cancers—a systematic review. Int J Colorectal Dis 35, 1663–1671 (2020). https://doi.org/10.1007/s00384-020-03687-8

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