Locally Recurrent Disease Related to Anal Canal Cancers

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Key points

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    Less than 20% of patients suffer locoregional failure after chemoradiation therapy for anal cancer.

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    Complete restaging with MRI pelvis and computed tomography–positron emission tomography followed by multidisciplinary tumor board discussion is required in all patients considered for surgery.

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    The ability to achieve R0 resection with acceptable morbidity determines the potential for salvage surgery, which may involve extensive resection of perineal soft tissue and/or pelvic organs with subsequent

History

A full account of the patient’s medical, surgical, and social history is obtained. Several points are of specific importance in the setting of locally recurrent anal cancer:

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    Does the patient have pain, weight loss; leg swelling; neurologic, obstructive, and/or urinary symptoms; or gynecologic symptoms in females? Importantly, symptoms present at the time of diagnosis may have implications for resectability and prognosis.4

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    When and where were the primary CRT treatments undertaken? Details of

Rehabilitation and recovery

Depending on the extent of the surgery, the rehabilitation process may be prolonged. The most common scenario involves an abdomino-perineal resection with flap closure. This necessitates stoma management and wound care teaching. Involvement of specialist stoma and wound care nurses, and an experienced physiotherapy service is prudent. Many patients have significant pain that is directly attributable to the neoplastic process or to the surgery itself. This symptom alone can become a major

Clinical results in the literature

The literature on management of anal cancer recurrence is limited to retrospective reviews with relatively small numbers (Table 1).29 The median 5-year overall and disease-free survival in patients undergoing planned curative resection is approximately 60%, and an R0 resection is achievable in the majority of patients (86%). Prognostic factors for survival and recurrence are T status and the presence of an involved margin.9 Other factors include the presence of metastatic lymph nodes (LNs), and

Summary

Surgery for anal cancer is usually reserved for patients with persistent disease or local recurrence after definitive CRT, which accounts for less than 20% of patients undergoing treatment. An important component of management is early detection of recurrences, and this is reliant on intensive clinical follow-up, particularly in high-risk cases. Patients with local recurrence should be re-evaluated fully for evidence of metastatic disease using PET-CT, and the local anatomy should be delineated

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    Disclosure Statement: The authors have nothing to disclose.

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