Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer

Andrew Renehan, A. G. Renehan, M. P. Saunders, P. F. Schofield, S. T. O'Dwyer

    Research output: Contribution to journalArticlepeer-review


    Background: Salvage surgery for anal cancer is usually reserved for local disease failure, but issues relating to the prediction of local failure and surgical outcome are ill defined. Methods: Between 1988 and 2000, 254 patients with non-metastatic anal epidermoid carcinoma were treated at a regional cancer centre with radiotherapy (n = 127) or chemoradiotherapy (n = 127). Results: There were 99 local disease failures (39.0 per cent), all but five occurring within 3 years of initial treatment. Increasing age (P <0.001, Cox model), total radiation dose (P = 0.004) and tumour stage (P = 0.010) were independent predictors of local failure. The overall 3- and 5-year survival rates after local disease failure were 46 and 29 per cent; the corresponding rates after salvage surgery (73 patients) were 55 and 40 per cent. A positive resection margin was the strongest negative predictor of survival after salvage surgery (P = 0.008, log rank test). Of 52 patients treated before the routine consideration of primary plastic reconstruction, delayed perineal wound healing occurred in 22 (42 per cent). Conclusion: In the management of anal cancer, local disease failure is a major clinical problem requiring early detection followed by radical surgery, often accompanied by plastic reconstruction. By implication, these factors favour the centralization of treatment for this uncommon cancer to a multidisciplinary oncology team. Copyright © 2005 British Journal of Surgery Society Ltd.
    Original languageEnglish
    Pages (from-to)605-614
    Number of pages9
    JournalBritish Journal of Surgery
    Issue number5
    Publication statusPublished - May 2005


    • Adult
    • Aged
    • Aged, 80 and over
    • drug therapy: Anus Neoplasms
    • drug therapy: Carcinoma, Squamous Cell
    • methods: Colostomy
    • Female
    • Follow-Up Studies
    • Humans
    • Male
    • Middle Aged
    • Neoplasm, Residual
    • etiology: Postoperative Complications
    • Proportional Hazards Models
    • Prospective Studies
    • methods: Salvage Therapy
    • Survival Analysis
    • Treatment Failure
    • Treatment Outcome


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