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Abdominal Perineal Resection Improves Survival for Nonmetastatic Adenocarcinoma of the Anal Canal

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There remains a lack of consensus regarding the optimal treatment for patients with curable adenocarcinoma of the anal canal (AAC). We sought to determine the role of definitive surgical resection and radiation in a large cohort of patients with AAC.

Materials and Methods

We queried the Surveillance, Epidemiology, and End Results (SEER) registry to identify all patients with nonmetastatic AAC from 1988 to 2004 and analyzed clinical factors, treatment modalities, and overall survival in this cohort. Kaplan–Meier survival curves were constructed to compare 5-year overall survival based on treatment groups: abdominal perineal resection (APR) only, APR and external beam radiation (APR and EBR), and EBR only. We performed a Cox regression analysis to determine factors predictive of outcome.

Results

A total of 165 patients were identified with nonmetastatic AAC. Of these, 30 patients were treated with an APR only, 42 patients with an APR and EBR, and 93 patients with EBR only. The 5-year survival for APR only, APR and EBR, and EBR only was 58%, 50%, and 30%, respectively. The difference in survival was statistically significant (APR vs. EBR, P = .02; APR and EBR vs. EBR, P = 0.04). Multivariate analysis completed on 86 patients in this cohort confirmed that factors accounting for the survival differences included age (P = 0.004), nodal stage (P = 0.001), and treatment groups (P = 0.03). The hazard ratio between EBR only compared with APR only was 2.78.

Conclusions

Definitive surgical treatment in the form of an APR with or without EBR is associated with improved survival in patients with AAC.

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Abbreviations

AAC:

Adenocarcinoma of the anal canal

SEER:

Surveillance, Epidemiology, and End Results registry

EBR:

External beam radiation

APR:

Abdominal perineal resection

References

  1. Whiteford MH, Stevens KR, Jr., Oh S, Deveney KE. The evolving treatment of anal cancer: how are we doing? Arch Surg. 2001;136:886–91.

    Article  PubMed  CAS  Google Scholar 

  2. Morson BC, Sobin LH. Histologic typing of intestinal tumors. Geneva: WHO, 1976.

    Google Scholar 

  3. Fenger C, Morson BC. Anal duct carcinoma. Dis Colon Rectum. 1989;32:355–7.

    Article  PubMed  CAS  Google Scholar 

  4. Joon DL, Chao MW, Ngan SY, Joon ML, Guiney MJ. Primary adenocarcinoma of the anus: a retrospective analysis. Int J Radiat Oncol Biol Phys. 1999;45:1199–205.

    Article  PubMed  CAS  Google Scholar 

  5. Abel ME, Chiu YS, Russell TR, Volpe PA. Adenocarcinoma of the anal glands: results of a survey. Dis Colon Rectum. 1993;36:383–7.

    Article  PubMed  CAS  Google Scholar 

  6. Basik M, Rodriguez-Bigas MA, Penetrante R, Petrelli NJ. Prognosis and recurrence patterns of anal adenocarcinoma. Am J Surg. 1995;169:233–7.

    Article  PubMed  CAS  Google Scholar 

  7. Belkacemi Y, Berger C, Poortmans P, Piel G, Zouhair A, Meric JB, et al. Management of primary anal canal adenocarcinoma: a large retrospective study from the Rare Cancer Network. Int J Radiat Oncol Biol Phys. 2003;56:1274–83.

    Article  PubMed  Google Scholar 

  8. Surveillance, Epidemiology, and End Results (SEER) Program, (www.seer.cancer.gov) Limited-Use Data (1973-2004), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2007. 7 A.D.

  9. Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin LH, Parkin DM, Whelan S. International Classification of Diseases for Oncology. 3rd ed. Geneva: World Heath Organization, 2000.

    Google Scholar 

  10. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM. American joint committee on cancer staging manual. Philadelphia: Springer, 2002.

    Google Scholar 

  11. Myerson RJ, Karnell LH, Menck HR. The National Cancer Data Base report on carcinoma of the anus. Cancer. 1997;80:805–15.

    Article  PubMed  CAS  Google Scholar 

  12. Merlini M, Eckert P. Malignant tumors of the anus: a study of 106 cases. Am J Surg. 1985;150:370–2.

    Article  PubMed  CAS  Google Scholar 

  13. Papagikos M, Crane CH, Skibber J, Janjan NA, Feig B, Rodriguez-Bigas MA, et al. Chemoradiation for adenocarcinoma of the anus. Int J Radiat Oncol Biol Phys. 2003;55:669–78.

    PubMed  Google Scholar 

  14. Behan W, Burnett R. Adenocarcinoma of the anal glands. J Clin Pathol. 1996;49:1009–11.

    Article  PubMed  CAS  Google Scholar 

  15. Hobbs CM, Lowry MA, Owen D, Sobin LH. Anal gland carcinoma. Cancer. 2001;92:2045–9.

    Article  PubMed  CAS  Google Scholar 

  16. Gaertner WB, Hagerman GF, Finne CO, Alavi K, Jessurun J, Rothenberger DA, et al. Fistula-associated anal adenocarcinoma: good results with aggressive therapy. Dis Colon Rectum. 2008;51:1061–7.

    Article  PubMed  Google Scholar 

  17. Goldstone SE, Winkler B, Ufford LJ, Alt E, Palefsky JM. High prevalence of anal squamous intraepithelial lesions and squamous-cell carcinoma in men who have sex with men as seen in a surgical practice. Dis Colon Rectum. 2001;44:690–8.

    Article  PubMed  CAS  Google Scholar 

  18. Palefsky JM, Holly EA, Ralston ML Arthur SP, Jay N, Berry JM, et al. Anal squamous intraepithelial lesions in HIV-positive and HIV-negative homosexual and bisexual men: prevalence and risk factors. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;17:320–6.

    PubMed  CAS  Google Scholar 

  19. Perkowski PE, Sorrells DL, Evans JT, Nopajaroonsri C, Johnson LW. Anal duct carcinoma: case report and review of the literature. Am Surg. 2000;66:1149–52.

    PubMed  CAS  Google Scholar 

  20. Jensen SL, Shokouh-Amiri MH, Hagen K, Harling H, Nielsen OV Adenocarcinoma of the anal ducts. A series of 21 cases. Dis Colon Rectum. 1988;31:268–72.

    Article  PubMed  CAS  Google Scholar 

  21. Wolff P, Peiffert D. In regard to Joon et al. IJROBP 1999;45:1199–1205. Int J Radiat Oncol Biol Phys. 2001;49:1517.

    CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, General and Oncologic Surgery, City of Hope, Duarte, CA, USA

    Nicole Kounalakis MD, Avo Artinyan MD, Benjamin Paz MD & Lily L. Lai MD

  2. Department of Biostatistics, City of Hope, Duarte, CA, USA

    David Smith PhD

  3. Auxilio Centro de Cancer, Hospital Auxilio Mutuo, San Juan, Puerto Rico

    Pablo Mojica-Manoso MD

Authors
  1. Nicole Kounalakis MD
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  2. Avo Artinyan MD
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  3. David Smith PhD
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  4. Pablo Mojica-Manoso MD
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  5. Benjamin Paz MD
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  6. Lily L. Lai MD
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Corresponding author

Correspondence to Nicole Kounalakis MD.

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Kounalakis, N., Artinyan, A., Smith, D. et al. Abdominal Perineal Resection Improves Survival for Nonmetastatic Adenocarcinoma of the Anal Canal. Ann Surg Oncol 16, 1310–1315 (2009). https://doi.org/10.1245/s10434-009-0392-x

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  • DOI: https://doi.org/10.1245/s10434-009-0392-x

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