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Erschienen in:
01.09.2011 | Original Article
Wide local excision for Buschke-Löwenstein tumor or circumferential carcinoma in situ
Erschienen in: Techniques in Coloproctology | Ausgabe 3/2011
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Purpose
This study aimed to evaluate the outcome of patients with Buschke-Löwenstein tumor or circumferential anal carcinoma in situ who underwent wide local excision with flap or skin graft coverage of the wound.
Methods
A retrospective review was conducted of all patients operated at Kaiser Permanente Los Angeles Medical Center during a 6-year period. Outcome measures included postoperative complications, functional results, recurrence rate, and re-intervention rate.
Results
Of 152 patients operated for dysplastic anal lesions or tumors, 10 (7%) underwent wide local excision for Buschke-Löwenstein tumor or circumferential anal carcinoma in situ [men 70%, mean age 36 years]. Median duration of symptoms was 5 years. Eighty percent of patients had prior operations and 50% were positive for the human immunodeficiency virus. Mean size of the lesion was 41 cm2. Microscopic margin positivity was noted in 60%. Wound was closed with house advancement flap in majority of patients. Only one patient had fecal diversion. Median length of stay was 2 days. Postoperative complications were noted in 50% of patients. Rate of transient postoperative incontinence was 30%. Recurrent disease was noted in 3 patients with the human immunodeficiency virus [median follow-up: 18 months]. All recurrences were treated with local fulguration or medication.
Conclusion
Wide local excision with flap or skin graft coverage is an option for patients with Buschke-Löwenstein tumor or circumferential anal carcinoma in situ. Close postoperative surveillance is advised due to the risk of recurrent disease, especially in patients with the human immunodeficiency virus.