ONCOLOGIC OUTCOMES OF SALVAGE ABDOMINOPERINEAL RESECTION FOR ANAL SQUAMOUS CELL CARCINOMA INITIALLY MANAGED WITH CHEMORADIATION.
Felipe F. Quezada*, Kashif Saeed, Iris H. Wei, Jesse Joshua Smith, Garrett Nash, Philip Paty, Jose Guillem, Martin Weiser, Julio Garcia-Aguilar, Emmanouil Pappou
Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY
BACKGROUND: Abdominoperineal resection (APR) has been advocated for persistent or recurrent disease after failure of chemoradiation (CRT) for anal squamous cell cancer (SCC). Treatment with salvage APR can potentially achieve cure. This study aimed to analyze oncological outcomes for salvage APR in a recent time period in a dedicated cancer center.
METHODS:This was a retrospective study including patients from 01.01.2007 to 31.12.2016. We included all patients who underwent APR for biopsy-proven persistent (<6 months after end of CRT) or recurrent (> 6 months) anal SCC. We excluded patients with metastasis at time of diagnosis and patients with missing data. Univariate analysis was performed with chi-square test for categorical variables, and non-parametric tests were performed for continuous variables. Kaplan Meier survival analysis was performed to evaluate relapse-free survival (RFS)
RESULTS:A total of 70 patients were included in the analysis: 27 (38%) with persistent disease and 43 (62%) with recurrent SCC after end of chemoradiation. Median follow up was 29 months. Thirty-eight patients (54%) underwent extended APR and/or pelvic exenteration, with a 25% morbidity and 1% mortality. A total of 24 (34%) patients developed local recurrence and systemic recurrence, with no patient develop systemic or local recurrence alone. Overall survival was 51% within the entire cohort. Relapse-free survival was 39%, with a median time to relapse of 19 months. In multivariate analysis, persistent disease as opposed to recurrent disease (HR 2.1; 95% CI 1.06 to 4.14), the presence of nodal disease in the APR specimen (HR 2.43; 95% CI 1.62 to 3.67), and microscopically incomplete (R1) resection (HR 2.64, 95% CI 1.12 to 6.19) were associated with worse RFS.
CONCLUSION:Salvage APR for anal SCC after failed CRT resulted in reasonable survival. Patients who undergo salvage APR for anal SCC should be counseled that persistent disease (vs. recurrence), finding positive lymph nodes in the APR specimen, and R1 resection increase the risk of disease relapse.
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