Skip to main content
Erschienen in: Diseases of the Colon & Rectum 10/2008

01.10.2008 | Original Contribution

Abdominoperineal Resection for Anal Cancer

verfasst von: P. Mariani, M.D., A. Ghanneme, M.D., A. De la Rochefordière, M.D., J. Girodet, M.D., M. C. Falcou, R. J. Salmon, M.D., Ph.D.

Erschienen in: Diseases of the Colon & Rectum | Ausgabe 10/2008

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Following initial radiotherapy or chemoradiotherapy for the treatment of anal cancer, patients who present with either persistent or locally recurrent disease are treated by abdominoperineal resection. The aim of this retrospective study was to review the long-term survival and prognostic factors after such surgery in a single institution.

Methods

Over a 34-year period (1969–2003), 422 patients with nonmetastatic anal cancer were treated with a curative intent. Of these, 83 (median age 61 years; 74 women) underwent abdominoperineal resection.

Results

Forty-one patients underwent abdominoperineal resection for persistent disease and 42 for locally recurrent disease. Postoperative mortality was 4.8 percent and morbidity was 35 percent with 18 percent having perineal wound infections. Median follow-up was 104 months (range, 3–299). The 3-year and 5-year actuarial survival was 62.8 and 56.5 percent respectively. Using univariate analysis, patients below 55 years, females, T1–2 tumors, N0-N1 lymphadenopathy and the absence of locally advanced tumor were associated with significantly improved survival. Surgery, whether for persistent or locally recurrent disease, did not affect the 5-year survival rate.

Conclusions

Abdominoperineal resection for nonmetastatic anal cancer is associated with a high morbidity rate but may result in long-term survival regardless of the indication.
Literatur
1.
Zurück zum Zitat Salmon RJ, Fenton J, Asselain B, et al. Treatment of epidermoid anal cancer. Am J Surg 1984;147:43–8.PubMedCrossRef Salmon RJ, Fenton J, Asselain B, et al. Treatment of epidermoid anal cancer. Am J Surg 1984;147:43–8.PubMedCrossRef
2.
Zurück zum Zitat Nigro ND, Vaitkevicius VK, Considine B Jr. Combined therapy for cancer of the anal cancer: a preliminary report. Dis Colon Rectum 1974;17:354–6.PubMedCrossRef Nigro ND, Vaitkevicius VK, Considine B Jr. Combined therapy for cancer of the anal cancer: a preliminary report. Dis Colon Rectum 1974;17:354–6.PubMedCrossRef
3.
Zurück zum Zitat Nigro ND, Seydel HG, Considine B, Vaitkevicius VK, Leichman L, Kinzie JJ. Combined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal cancer. Cancer 1983;51:1826–9.PubMedCrossRef Nigro ND, Seydel HG, Considine B, Vaitkevicius VK, Leichman L, Kinzie JJ. Combined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal cancer. Cancer 1983;51:1826–9.PubMedCrossRef
4.
Zurück zum Zitat UKCCR anal cancer trial working party. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet 1996;348:1049–54.CrossRef UKCCR anal cancer trial working party. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet 1996;348:1049–54.CrossRef
5.
Zurück zum Zitat Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal cancer: results of a phase III randomized intergroup study. J Clin Oncol 1996;14:2527–39.PubMed Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal cancer: results of a phase III randomized intergroup study. J Clin Oncol 1996;14:2527–39.PubMed
6.
Zurück zum Zitat Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for research and treatment of cancer radiotherapy and gastrointestinal cooperative groups. J Clin Oncol 1997;15:2040–9.PubMed Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for research and treatment of cancer radiotherapy and gastrointestinal cooperative groups. J Clin Oncol 1997;15:2040–9.PubMed
7.
Zurück zum Zitat Cummings BJ, Keane TJ, O’Sullivan B, Wong CS, Catton CN. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C. Int J Radiat Oncol Biol Phys 1991;21:1115–25.PubMed Cummings BJ, Keane TJ, O’Sullivan B, Wong CS, Catton CN. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C. Int J Radiat Oncol Biol Phys 1991;21:1115–25.PubMed
8.
Zurück zum Zitat Meeker WR Jr, Sickle-Santanello BJ, Philpott G, et al. Combined chemotherapy, radiation, and surgery for epithelial cancer of the anal cancer. Cancer 1986;57:525–9.PubMedCrossRef Meeker WR Jr, Sickle-Santanello BJ, Philpott G, et al. Combined chemotherapy, radiation, and surgery for epithelial cancer of the anal cancer. Cancer 1986;57:525–9.PubMedCrossRef
9.
Zurück zum Zitat Sischy B, Doggett RL, Krall JM, et al. Definitive irradiation and chemotherapy for radiosensitization in management of anal carcinoma: interim report on Radiation Therapy Oncology Group Study No. 8314. J Natl Cancer Inst 1989;81:850–6.PubMedCrossRef Sischy B, Doggett RL, Krall JM, et al. Definitive irradiation and chemotherapy for radiosensitization in management of anal carcinoma: interim report on Radiation Therapy Oncology Group Study No. 8314. J Natl Cancer Inst 1989;81:850–6.PubMedCrossRef
10.
Zurück zum Zitat Habr-Gama A, da Silva e Sousa Junior AH, Nadalin W, Gansl R, da Silva JH, Pinotti HW. Epidermoid carcinoma of the anal canal. Results of treatment by combined chemotherapy and radiation therapy. Dis Colon Rectum 1989;32:773–7.PubMedCrossRef Habr-Gama A, da Silva e Sousa Junior AH, Nadalin W, Gansl R, da Silva JH, Pinotti HW. Epidermoid carcinoma of the anal canal. Results of treatment by combined chemotherapy and radiation therapy. Dis Colon Rectum 1989;32:773–7.PubMedCrossRef
11.
Zurück zum Zitat Cummings BJ. Concomitant radiotherapy and chemotherapy for anal cancer. Semin Oncol 1992;19:102–8.PubMed Cummings BJ. Concomitant radiotherapy and chemotherapy for anal cancer. Semin Oncol 1992;19:102–8.PubMed
12.
Zurück zum Zitat Renehan AG, Saunders MP, Schofield PF, O’Dwyer ST. Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer. Br J Surg 2005;92:605–14.PubMedCrossRef Renehan AG, Saunders MP, Schofield PF, O’Dwyer ST. Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer. Br J Surg 2005;92:605–14.PubMedCrossRef
13.
Zurück zum Zitat Ryan DP, Compton CC, Mayer RJ. Carcinoma of the anal cancer. N Engl J Med 2000;342:792–800.PubMedCrossRef Ryan DP, Compton CC, Mayer RJ. Carcinoma of the anal cancer. N Engl J Med 2000;342:792–800.PubMedCrossRef
14.
Zurück zum Zitat Nilsson PJ, Svensson C, Goldman S, Glimelius B. Salvage abdominoperineal resection in anal epidermoid cancer. Br J Surg 2002;89:1425–9.PubMedCrossRef Nilsson PJ, Svensson C, Goldman S, Glimelius B. Salvage abdominoperineal resection in anal epidermoid cancer. Br J Surg 2002;89:1425–9.PubMedCrossRef
15.
Zurück zum Zitat Allal AS, Laurencet FM, Reymond MA, Kurtz JM, Marti MC. Effectiveness of surgical salvage therapy for patients with locally uncontrolled anal carcinoma after sphincter-conserving treatment. Cancer 1999;86:405–9.PubMedCrossRef Allal AS, Laurencet FM, Reymond MA, Kurtz JM, Marti MC. Effectiveness of surgical salvage therapy for patients with locally uncontrolled anal carcinoma after sphincter-conserving treatment. Cancer 1999;86:405–9.PubMedCrossRef
16.
Zurück zum Zitat Pocard M, Tiret E, Nugent K, Dehni N, Parc R. Results of salvage abdominoperineal resection for anal cancer after radiotherapy. Dis Colon Rectum 1998;4l:l488–93. Pocard M, Tiret E, Nugent K, Dehni N, Parc R. Results of salvage abdominoperineal resection for anal cancer after radiotherapy. Dis Colon Rectum 1998;4l:l488–93.
17.
Zurück zum Zitat Chauveinc L, Buthaud X, Falcou MC, et al. Anal cancer treatment: practical limitations of routine prescription of concurrent chemotherapy and radiotherapy. Br J Cancer 2003;89:2057–61.PubMedCrossRef Chauveinc L, Buthaud X, Falcou MC, et al. Anal cancer treatment: practical limitations of routine prescription of concurrent chemotherapy and radiotherapy. Br J Cancer 2003;89:2057–61.PubMedCrossRef
18.
Zurück zum Zitat Mullen JT, Rodriguez-Bigas MA, Chang GJ, et al. Results of surgical salvage after failed chemoradiation therapy for epidermoid carcinoma of the anal cancer. Ann Surg Oncol 2007;14:478–83.PubMedCrossRef Mullen JT, Rodriguez-Bigas MA, Chang GJ, et al. Results of surgical salvage after failed chemoradiation therapy for epidermoid carcinoma of the anal cancer. Ann Surg Oncol 2007;14:478–83.PubMedCrossRef
19.
Zurück zum Zitat Berthoux L, Labib A, Clough KB, Girodet J, Salmon RJ. Hernie périnéale après amputation abdomino-périnéale. Rôle de l’epiplooplastie et/ou de l’irradiation. J Chir 1992;129:550–2. Berthoux L, Labib A, Clough KB, Girodet J, Salmon RJ. Hernie périnéale après amputation abdomino-périnéale. Rôle de l’epiplooplastie et/ou de l’irradiation. J Chir 1992;129:550–2.
20.
Zurück zum Zitat Kroll SS, Pollock R, Jessup JM, Ota D. Transpelvic rectus abdominis flap reconstruction of defects following abdominal-perineal resection. Am Surg 1989;55:632–7.PubMed Kroll SS, Pollock R, Jessup JM, Ota D. Transpelvic rectus abdominis flap reconstruction of defects following abdominal-perineal resection. Am Surg 1989;55:632–7.PubMed
21.
Zurück zum Zitat Giampapa V, Keller A, Shaw WW, Colen SR. Pelvic floor reconstruction using the rectus abdominis flap. Ann Plast Surg 1984;13:56–9.PubMedCrossRef Giampapa V, Keller A, Shaw WW, Colen SR. Pelvic floor reconstruction using the rectus abdominis flap. Ann Plast Surg 1984;13:56–9.PubMedCrossRef
22.
Zurück zum Zitat Taylor GI, Corlett R, Boyd JB. The extended deep inferior epigastric flap: a clinical technique. Plast Reconstr Surg 1983;72:751–65.PubMedCrossRef Taylor GI, Corlett R, Boyd JB. The extended deep inferior epigastric flap: a clinical technique. Plast Reconstr Surg 1983;72:751–65.PubMedCrossRef
23.
Zurück zum Zitat Bell SW, Dehni N, Chaouat M, Lifante JC, Parc R, Tiret E. Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection. Br J Surg 2005;92:482–6.PubMedCrossRef Bell SW, Dehni N, Chaouat M, Lifante JC, Parc R, Tiret E. Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection. Br J Surg 2005;92:482–6.PubMedCrossRef
24.
Zurück zum Zitat De Hass WG, Miller MJ, Temple WJ, et al. Perineal wound closure with the rectus abdominis musculocutaneous flap after tumor ablation. Ann Surg Oncol 1995;2:400–6.CrossRef De Hass WG, Miller MJ, Temple WJ, et al. Perineal wound closure with the rectus abdominis musculocutaneous flap after tumor ablation. Ann Surg Oncol 1995;2:400–6.CrossRef
25.
Zurück zum Zitat Ghouti L, Houvenaeghel G, Moutardier V, et al. Salvage abdominoperineal resection after failure of conservative treatment in anal epidermoid cancer. Dis Colon Rectum 2005;48:16–22.PubMedCrossRef Ghouti L, Houvenaeghel G, Moutardier V, et al. Salvage abdominoperineal resection after failure of conservative treatment in anal epidermoid cancer. Dis Colon Rectum 2005;48:16–22.PubMedCrossRef
26.
Zurück zum Zitat Bakx R, Van Lanschot JJ, Zoetmulder FA. Inferiorly based rectus abdominis myocutaneous flaps in surgical oncology: indications, technique, and experience in 37 patients. J Surg Oncol 2004;85:93–7.PubMedCrossRef Bakx R, Van Lanschot JJ, Zoetmulder FA. Inferiorly based rectus abdominis myocutaneous flaps in surgical oncology: indications, technique, and experience in 37 patients. J Surg Oncol 2004;85:93–7.PubMedCrossRef
27.
Zurück zum Zitat Ellenhorn JD, Enker WE, Quan SH. Salvage abdomino-perineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus. Ann Surg Oncol 1994;1:105–10.PubMedCrossRef Ellenhorn JD, Enker WE, Quan SH. Salvage abdomino-perineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus. Ann Surg Oncol 1994;1:105–10.PubMedCrossRef
28.
Zurück zum Zitat Smith AJ, Whelan P, Cummings BJ, Stern HS. Management of persistent or locally recurrent epidermoid cancer of the anal cancer with abdominoperineal resection. Acta Oncol 2001;40:34–6.PubMedCrossRef Smith AJ, Whelan P, Cummings BJ, Stern HS. Management of persistent or locally recurrent epidermoid cancer of the anal cancer with abdominoperineal resection. Acta Oncol 2001;40:34–6.PubMedCrossRef
29.
Zurück zum Zitat Van der wal BC, Cleffken BI, Gulec B, Kaufman HS, Choti MA. Results of salvage abdominoperineal resection for recurrent anal carcinoma following combined chemoradiation therapy. J Gastrointest Surg 2001;5:383–7.PubMedCrossRef Van der wal BC, Cleffken BI, Gulec B, Kaufman HS, Choti MA. Results of salvage abdominoperineal resection for recurrent anal carcinoma following combined chemoradiation therapy. J Gastrointest Surg 2001;5:383–7.PubMedCrossRef
30.
Zurück zum Zitat Akbari RP, Paty PB, Guillem JG, et al. Oncologic outcomes of salvage surgery for epidermoid carcinoma of the anus initially managed with combined modality therapy. Dis Colon Rectum 2004;47:1136–44.PubMedCrossRef Akbari RP, Paty PB, Guillem JG, et al. Oncologic outcomes of salvage surgery for epidermoid carcinoma of the anus initially managed with combined modality therapy. Dis Colon Rectum 2004;47:1136–44.PubMedCrossRef
Metadaten
Titel
Abdominoperineal Resection for Anal Cancer
verfasst von
P. Mariani, M.D.
A. Ghanneme, M.D.
A. De la Rochefordière, M.D.
J. Girodet, M.D.
M. C. Falcou
R. J. Salmon, M.D., Ph.D.
Publikationsdatum
01.10.2008
Verlag
Springer-Verlag
Erschienen in
Diseases of the Colon & Rectum / Ausgabe 10/2008
Print ISSN: 0012-3706
Elektronische ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-008-9361-x

Weitere Artikel der Ausgabe 10/2008

Diseases of the Colon & Rectum 10/2008 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.