Salvage Anal Cancer Surgery (SACS)

Published Date: 19th July 2016

Publication Authors: Liew S

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Introduction:  2004 NICE guidance on anal carcinomas advised treatment by specific multidisciplinary teams (MDTs). The National Peer Review Programme recommended each cancer network have a single anal carcinoma MDT and single salvage surgery centre. We present the results of this service.

Methods:  A retrospective case note audit was performed of all patients having SACS at our tertiary centre. A database was created including demographics, type, dose and duration of chemoradiotherapy, histology, local recurrence and survival.

Results:  Nineteen patients (14F:5M, median age 62, range 37–80 years) underwent SACS. Chemoradiotherapy was given as in the ACT II protocol. Surgery involved a colorectal and plastic surgeon performing a posterior exenteration with vaginal reconstruction or cystectomy if required. Tumours were staged (T0 = 1, T1 = 1, T2 = 4, T3 = 6, T4 = 7) with nodal metastases in four cases (N1 = 3, N2 = 1), distant metastases in one case and a positive resection margin in four cases. Fifteen patients required flap reconstruction, eight developed flap related complications (six superficial dehiscence and delayed healing and two flap necrosis). Two patients (both T4, R1) died from adhesive small bowel obstruction (one 30 day mortality). Four patients died of recurrent disease, median follow-up 16 months (1–69).

Conclusion:  SACS has been safely established with good rates of R0 resections and recurrence. The high proportion of patients with T3/T4 disease is concerning. Flap morbidity remains a problem.

Bullen, TF; Liew, S; Haylock, B; Myint, AS; Carter, PS; Rooney, PS. (2012).  Outcomes and disease control of salvage anal cancer surgery (SACS) post NICE 2004 . Colorectal Disease. 14 (Supplement S1), 17

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