Annals of Surgical Oncology

, Volume 1, Issue 2, pp 105–110 | Cite as

Salvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus

  • Joshua D. I. Ellenhorn
  • Warren E. Enker
  • Stuart H. Q. Quan


Background: Up to one-third of patients with anal epidermoid cancer will fail initial chemoradiotherapy (CT-RT) or have local recurrence after treatment. This study evaluates the Memorial Sloan-Kettering Cancer Center (MSKCC) experience with salvage abdominoperineal resection (APR) in these patients.

Methods: Thirty-eight patients who underwent salvage APR following 5-fluorouracil (5-FU), mitomycin C, and radiotherapy over the past 12 years were analyzed by retrospective review. Survival was calculated by the Kaplan-Meier method and comparisons by log-rank analysis.

Results: The indications for APR were recurrent disease after CT-RT in 14 patients and persistent disease in 24 patients. Median follow-up time and survival were 47 and 41 months, respectively. The actuarial 5-year survival was 44%. Twenty-three patients had recurrent disease after APR. Inguinal lymphadenopathy at initial presentation (p<0.05), fixation of tumor to the pelvic sidewall (p<0.01), and pathologic involvement of the perirectal fat (p<0.01) adversely affected survival. Age, gender, initial response to CT-RT, initial stage of the primary tumor, histologic levator muscle involvement, status of perirectal lymph nodes, and extent of lymphadenectomy did not affect survival.

Conclusions: Salvage APR can be expected to yield a moderate number of long-term survivors, but the high rate of disseminated failure suggests the need for additional postoperative treatment.

Key Words

Anal cancer Abdominoperineal resection Chemoradiotherapy Treatment failure 


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Copyright information

© The Society of Surgical Oncology, Inc. 1994

Authors and Affiliations

  • Joshua D. I. Ellenhorn
    • 1
  • Warren E. Enker
    • 2
  • Stuart H. Q. Quan
    • 2
  1. 1.From the Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Colorectal ServiceMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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