Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer.

2.50
Hdl Handle:
http://hdl.handle.net/10541/76475
Title:
Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer.
Authors:
Renehan, Andrew G; Saunders, Mark P; Schofield, Philip F; O'Dwyer, Sarah T
Abstract:
BACKGROUND: Salvage surgery for anal cancer is usually reserved for local disease failure, but issues relating to the prediction of local failure and surgical outcome are ill defined. METHODS: Between 1988 and 2000, 254 patients with non-metastatic anal epidermoid carcinoma were treated at a regional cancer centre with radiotherapy (n = 127) or chemoradiotherapy (n = 127). RESULTS: There were 99 local disease failures (39.0 per cent), all but five occurring within 3 years of initial treatment. Increasing age (P < 0.001, Cox model), total radiation dose (P = 0.004) and tumour stage (P = 0.010) were independent predictors of local failure. The overall 3- and 5-year survival rates after local disease failure were 46 and 29 per cent; the corresponding rates after salvage surgery (73 patients) were 55 and 40 per cent. A positive resection margin was the strongest negative predictor of survival after salvage surgery (P = 0.008, log rank test). Of 52 patients treated before the routine consideration of primary plastic reconstruction, delayed perineal wound healing occurred in 22 (42 per cent). CONCLUSION: In the management of anal cancer, local disease failure is a major clinical problem requiring early detection followed by radical surgery, often accompanied by plastic reconstruction. By implication, these factors favour the centralization of treatment for this uncommon cancer to a multidisciplinary oncology team.
Affiliation:
Department of Surgery, Christie Hospital NHS Trust, Manchester, UK. arenehan@picr.man.ac.uk <arenehan@picr.man.ac.uk>
Citation:
Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer. 2005, 92 (5):605-14 Br J Surg
Journal:
The British Journal of Surgery
Issue Date:
May-2005
URI:
http://hdl.handle.net/10541/76475
DOI:
10.1002/bjs.4908
PubMed ID:
15739215
Type:
Article
Language:
en
ISSN:
0007-1323
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorRenehan, Andrew G-
dc.contributor.authorSaunders, Mark P-
dc.contributor.authorSchofield, Philip F-
dc.contributor.authorO'Dwyer, Sarah T-
dc.date.accessioned2009-08-06T10:13:22Z-
dc.date.available2009-08-06T10:13:22Z-
dc.date.issued2005-05-
dc.identifier.citationPatterns of local disease failure and outcome after salvage surgery in patients with anal cancer. 2005, 92 (5):605-14 Br J Surgen
dc.identifier.issn0007-1323-
dc.identifier.pmid15739215-
dc.identifier.doi10.1002/bjs.4908-
dc.identifier.urihttp://hdl.handle.net/10541/76475-
dc.description.abstractBACKGROUND: Salvage surgery for anal cancer is usually reserved for local disease failure, but issues relating to the prediction of local failure and surgical outcome are ill defined. METHODS: Between 1988 and 2000, 254 patients with non-metastatic anal epidermoid carcinoma were treated at a regional cancer centre with radiotherapy (n = 127) or chemoradiotherapy (n = 127). RESULTS: There were 99 local disease failures (39.0 per cent), all but five occurring within 3 years of initial treatment. Increasing age (P < 0.001, Cox model), total radiation dose (P = 0.004) and tumour stage (P = 0.010) were independent predictors of local failure. The overall 3- and 5-year survival rates after local disease failure were 46 and 29 per cent; the corresponding rates after salvage surgery (73 patients) were 55 and 40 per cent. A positive resection margin was the strongest negative predictor of survival after salvage surgery (P = 0.008, log rank test). Of 52 patients treated before the routine consideration of primary plastic reconstruction, delayed perineal wound healing occurred in 22 (42 per cent). CONCLUSION: In the management of anal cancer, local disease failure is a major clinical problem requiring early detection followed by radical surgery, often accompanied by plastic reconstruction. By implication, these factors favour the centralization of treatment for this uncommon cancer to a multidisciplinary oncology team.en
dc.language.isoenen
dc.subjectAnus Canceren
dc.subjectCanceren
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAged, 80 and over-
dc.subject.meshAnus Neoplasms-
dc.subject.meshCarcinoma, Squamous Cell-
dc.subject.meshColostomy-
dc.subject.meshFemale-
dc.subject.meshFollow-Up Studies-
dc.subject.meshHumans-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshNeoplasm, Residual-
dc.subject.meshPostoperative Complications-
dc.subject.meshProportional Hazards Models-
dc.subject.meshProspective Studies-
dc.subject.meshSalvage Therapy-
dc.subject.meshSurvival Analysis-
dc.subject.meshTreatment Failure-
dc.subject.meshTreatment Outcome-
dc.titlePatterns of local disease failure and outcome after salvage surgery in patients with anal cancer.en
dc.typeArticleen
dc.contributor.departmentDepartment of Surgery, Christie Hospital NHS Trust, Manchester, UK. arenehan@picr.man.ac.uk <arenehan@picr.man.ac.uk>en
dc.identifier.journalThe British Journal of Surgeryen

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