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Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?
Author(s) -
Fields Adam C.,
Melnitchouk Nelya,
Senturk James,
Irani Jennifer,
Bleday Ronald,
Goldberg Joel
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25489
Subject(s) - medicine , abdominoperineal resection , chemoradiotherapy , anal cancer , hazard ratio , surgery , salvage therapy , survival rate , carcinoma , radiation therapy , confidence interval , oncology , cancer , colorectal cancer , chemotherapy
Background/Objectives The first‐line treatment for anal squamous cell carcinoma is Nigro protocol chemoradiotherapy. Some patients will fail curative intent chemoradiotherapy and have persistent disease while others may have an initial response followed by disease recurrence. The goal of this study is to investigate survival in anal squamous cell carcinoma patients who fail first‐line treatment. Methods The National Cancer Database (2004‐2013) was used to identify patients with anal squamous cell carcinoma. The primary outcome was overall survival. Results There were 256 patients in the early salvage group who underwent abdominoperineal resection (APR) within 6 months of completing chemoradiotherapy and 181 patients in the late salvage group who had APR 6 months or more after completion of chemoradiotherapy. Both groups of patients had similar tumor size (45 vs 50 mm; P = 0.07) and rate of positive margins (21.5% vs 15.6%; P = 0.13). There was no significant difference in overall survival between early and late salvage APR (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.50‐1.32; P = 0.40). Conclusions The overall survival of anal squamous cell carcinoma patients undergoing early vs late salvage APR after failure of chemoradiotherapy is similar. As a result, patients with persistent disease should be offered surgery just as readily as those with recurrent disease.