Results of Surgical Salvage Treatment for Anal Canal Cancer

In this blog/article, we will have a detailed study on the results of Surgical Salvage treatment in respective to Anal canal cancer. But, before you See More about this, first, let us understand what is anal cancer. How is it formed?

Sometimes, cancer cells tend to transform into benign or malignant tumours in the tissues of the anus. This tumour causes anal cancer. This anus is located at the bottom of your intestines. It is the opening where your stool leaves the body. 

However, reports speak that anal cancer is rarely found in human beings. But, whenever it occurs, it spreads to all parts of the human body. Besides, noncancerous forms of anal cancer also get converted into cancerous in a period.

Anal cancer accounts for only 2 to 4 % of all anorectal neoplasms. In the current scenario, radiotherapy or concomitant chemoradiotherapy is a standard treatment for the patients. They have been quite successful in controlling the disease. However, no randomized study is found yet, which can compare various types of salvage approaches. 

Materials and Methods Used

In the year from 1978 to 1994, about 83 patients with biopsy-proven anal canal cancer were treated. They received curative intent at the Cancer Hospital of the Chinese Academy of Medical Sciences (CAMS). 

In the treatment, primary radiotherapy was not able to produce any regression of the primary tumour in about 16 patients. So, these 16, including 5 facing a recurrent disease and 11 with a persistent illness, got the treatment of salvage surgery. 

Treatment

Among these 16, 15 patients got External Beam Radiation Therapy (EBRT). This EBRT had a mean dose of 40 Gy(ranging 30 – 75 Gy). One patient thereby received 192Ir sources after the EBRT process. Brachytherapy dose was reported 14 Gy. 

But, adjuvant or concomitant chemotherapy was not used with the patients. When primary treatment was finished, these patients were followed up according to a standard protocol.

Let us See More and have a look at some of the results of anal cancer surgery:

Surgical results

Now, 16 patients who were not able to pass the initial therapy, 14 out of them underwent salvage abdominoperineal resection (APR), and the remaining two received transanal local excision. Also, two males received partial prostatic resection. No deaths were reported attributable to operation. 

Well, 14 patients had perineal wounds open for a bath. It was considered that the perineal wound should heal within three months. However, the period of 3 months exceeded in case of 8 patients. Also, it took more than six months to heal the wounds of 4 patients, and one patient failed to heal the wound within two years. 

Besides that, five patients saw other complications unrelated to perineal wounds, such as one perineal urethral fistula after prostatic resection, one small bowel obstruction treated conservatively, one abdominal wound infection and two nephrocystitis.

Oncological results

Now, the median follow-up time for all patients was 120 (range 5 – 245) months after salvage surgery. With a mean survival time of 16(range 5 – 27) months, nine patients died of disease progression, at the time of the last follow-up. Among these patients, eight patients were presented with persistent disease, and 1 had recurrent disease.

Survivors had a median follow-up time of 173 (range 98 – 245) months, and six patients survived for more than ten years. Initial tumour stage showed 1 out of 7 patients with T2N0M0 died 18 months after resection. However, 8 out of 9 patients with T1-4N2-3M0 disease were not controlled. Also, out of the 16, only one patient was found with a second locoregional disease recurrence and further salvaged with radiotherapy.

Conclusion

In conclusion, salvage APR after radiotherapy can be said to have a high complication rate. But, it can bring a long-time survival in several patients with anal cancer.  

Now, since the patients with T4 and N2-3 tumours did not receive much benefit from salvage anal cancer surgery, further investigation is much needed in case of salvage chemoradiotherapy.