Schiller Dan E, Cummings Bernard J, Rai Sundeep, Le Lisa W, Last Linda, Davey Phil, Easson Alexandra, Smith Andrew J, Swallow Carol J
Department of Surgery, Mount Sinai Hospital, University of Toronto, Suite 1224, 600 University Avenue, M5G 1X5, Toronto, Ontario, Canada.
Ann Surg Oncol. 2007 Oct;14(10):2780-9. doi: 10.1245/s10434-007-9491-8. Epub 2007 Jul 20.
For patients with anal canal cancer who fail combined modality treatment (CMT), salvage surgery (SS) offers the potential for long term survival. The literature regarding SS is limited by small patient numbers and/or heterogeneous treatment protocols. We report on a large series of patients initially treated with chemoradiation at a major referral center.
We identified 60 patients with persistent or recurrent anal cancer who had undergone SS; 20 were excluded. Overall and disease-free survival (OS, DFS) curves were constructed using the Kaplan Meier method. Univariate analysis was done using the Log-Rank test, and multivariable analysis using Cox proportional hazards.
The 40 patients (29 women, 11 men, median age 57) underwent curative intent resection. The initial procedure was multivisceral resection (n = 24), abdominoperineal resection alone (n = 14) or local excision (n = 2). Postoperative mortality was 5%. Postoperative complications were seen in 72%. Median follow-up was 18 months overall and 36 months in survivors. Median OS was 41 months; OS and disease free survival at 5 years were 39% and 30%, respectively. Recurrence was present in 21 patients at time of analysis. Failure was locoregional in 86% (18 of 21) and distant in 48% (10 of 21). Independent predictors of poor OS were male gender, Charlson Comorbidity Score and tumor size. Independent predictors of poor disease free survival were positive margins and lymphovascular invasion.
SS for anal canal cancer was associated with significant morbidity. Long-term survival was achieved in 39% of patients. Comorbidities should guide patient selection, and R0 resection should be the goal.
对于联合模式治疗（CMT）失败的肛管癌患者，挽救性手术（SS）提供了长期生存的可能性。关于SS的文献受到患者数量少和/或治疗方案异质性的限制。我们报告了在一个主要转诊中心最初接受放化疗的大量患者系列。
我们确定了60例接受过SS的持续性或复发性肛管癌患者；排除20例。使用Kaplan-Meier方法构建总生存（OS）和无病生存（DFS）曲线。单变量分析使用Log-Rank检验，多变量分析使用Cox比例风险模型。
40例患者（29例女性，11例男性，中位年龄57岁）接受了根治性切除。初始手术为多脏器切除（n = 24）、单纯腹会阴联合切除（n = 14）或局部切除（n = 2）。术后死亡率为5%。72%的患者出现术后并发症。总体中位随访时间为18个月，幸存者为36个月。中位OS为41个月；5年时的OS和无病生存率分别为39%和30%。分析时21例患者出现复发。86%（21例中的18例）为局部区域复发，48%（21例中的10例）为远处复发。OS差的独立预测因素为男性、Charlson合并症评分和肿瘤大小。无病生存差的独立预测因素为切缘阳性和淋巴管浸润。
肛管癌的SS与显著的发病率相关。39%的患者实现了长期生存。合并症应指导患者选择，R0切除应作为目标。
