[The role of radical surgery in the treatment of epidermoid carcinoma of the anal canal].

In order to define the role of radical surgery in the actual treatment of epidermoid carcinoma of the anal canal (ECAC), we retrospectively reviewed the charts of patients with primary ECAC, treated with radical surgery in the Hospital de Oncología, National Medical Center IMSS. We analyzed the recurrence pattern, its treatment and the contemporary literature was reviewed. From 1975 to 1990, we treated 16 patients; 13 females, 3 males, mean age was 64 years. The presurgical stage was T2, 6; T3 7; T4, 3. An abdominoperineal resection was performed in 12 patients; a posterior pelvic exenteration in 3; a total pelvic exenteration in 1. Ten patients developed surgical complications, 4 of them were major, 2 required surgical reintervention. There was no operative mortality. We obtained local tumor control in 5/16 patients (32%); the local recurrence by stage were T2, 3/6 (50%); T3, 5/7 (71%); T4, 3/3 (100%) p = 0.04. Ten of them were located at the pelvis brim and 1 was located to the central pelvis (vagina, perineum), 9 were treated with radiation therapy (RT) a mean dose of 45 Gy, only the patient with central local recurrence obtained local tumor control. Regional recurrences were as follows: T2 patients, 1/6 (16%); T3, 2/7 (28%); T4, 2/3 (66%). The 2 patients with metachronous inguinal lymph node metastases were treated with a radical groin dissection, with tumor control. In conclusion, the radical surgical treatment is associated with a low loco-regional tumor control; the pelvic tumor relapses were located at the pelvis brim and with no response to RT. With the results herein obtained and the results with other treatment modalities such as RT and its associations with chemotherapy (C) in regard to local tumor control, the actual role of the radical surgical treatment in the salvage of central pelvic relapses to primary treatment with RT or C-RT.