Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2009

01-05-2009 | Gastrointestinal Oncology

Abdominal Perineal Resection Improves Survival for Nonmetastatic Adenocarcinoma of the Anal Canal

Authors: Nicole Kounalakis, MD, Avo Artinyan, MD, David Smith, PhD, Pablo Mojica-Manoso, MD, Benjamin Paz, MD, Lily L. Lai, MD

Published in: Annals of Surgical Oncology | Issue 5/2009

Login to get access

Abstract

Background

There remains a lack of consensus regarding the optimal treatment for patients with curable adenocarcinoma of the anal canal (AAC). We sought to determine the role of definitive surgical resection and radiation in a large cohort of patients with AAC.

Materials and Methods

We queried the Surveillance, Epidemiology, and End Results (SEER) registry to identify all patients with nonmetastatic AAC from 1988 to 2004 and analyzed clinical factors, treatment modalities, and overall survival in this cohort. Kaplan–Meier survival curves were constructed to compare 5-year overall survival based on treatment groups: abdominal perineal resection (APR) only, APR and external beam radiation (APR and EBR), and EBR only. We performed a Cox regression analysis to determine factors predictive of outcome.

Results

A total of 165 patients were identified with nonmetastatic AAC. Of these, 30 patients were treated with an APR only, 42 patients with an APR and EBR, and 93 patients with EBR only. The 5-year survival for APR only, APR and EBR, and EBR only was 58%, 50%, and 30%, respectively. The difference in survival was statistically significant (APR vs. EBR, P = .02; APR and EBR vs. EBR, P = 0.04). Multivariate analysis completed on 86 patients in this cohort confirmed that factors accounting for the survival differences included age (P = 0.004), nodal stage (P = 0.001), and treatment groups (P = 0.03). The hazard ratio between EBR only compared with APR only was 2.78.

Conclusions

Definitive surgical treatment in the form of an APR with or without EBR is associated with improved survival in patients with AAC.
Literature
1.
Whiteford MH, Stevens KR, Jr., Oh S, Deveney KE. The evolving treatment of anal cancer: how are we doing? Arch Surg. 2001;136:886–91.PubMedCrossRef
2.
Morson BC, Sobin LH. Histologic typing of intestinal tumors. Geneva: WHO, 1976.
3.
4.
Joon DL, Chao MW, Ngan SY, Joon ML, Guiney MJ. Primary adenocarcinoma of the anus: a retrospective analysis. Int J Radiat Oncol Biol Phys. 1999;45:1199–205.PubMedCrossRef
5.
Abel ME, Chiu YS, Russell TR, Volpe PA. Adenocarcinoma of the anal glands: results of a survey. Dis Colon Rectum. 1993;36:383–7.PubMedCrossRef
6.
Basik M, Rodriguez-Bigas MA, Penetrante R, Petrelli NJ. Prognosis and recurrence patterns of anal adenocarcinoma. Am J Surg. 1995;169:233–7.PubMedCrossRef
7.
Belkacemi Y, Berger C, Poortmans P, Piel G, Zouhair A, Meric JB, et al. Management of primary anal canal adenocarcinoma: a large retrospective study from the Rare Cancer Network. Int J Radiat Oncol Biol Phys. 2003;56:1274–83.PubMedCrossRef
8.
Surveillance, Epidemiology, and End Results (SEER) Program, (www.​seer.​cancer.​gov) Limited-Use Data (1973-2004), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2007. 7 A.D.
9.
Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin LH, Parkin DM, Whelan S. International Classification of Diseases for Oncology. 3rd ed. Geneva: World Heath Organization, 2000.
10.
Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM. American joint committee on cancer staging manual. Philadelphia: Springer, 2002.
11.
Myerson RJ, Karnell LH, Menck HR. The National Cancer Data Base report on carcinoma of the anus. Cancer. 1997;80:805–15.PubMedCrossRef
12.
Merlini M, Eckert P. Malignant tumors of the anus: a study of 106 cases. Am J Surg. 1985;150:370–2.PubMedCrossRef
13.
Papagikos M, Crane CH, Skibber J, Janjan NA, Feig B, Rodriguez-Bigas MA, et al. Chemoradiation for adenocarcinoma of the anus. Int J Radiat Oncol Biol Phys. 2003;55:669–78.PubMed
14.
15.
16.
Gaertner WB, Hagerman GF, Finne CO, Alavi K, Jessurun J, Rothenberger DA, et al. Fistula-associated anal adenocarcinoma: good results with aggressive therapy. Dis Colon Rectum. 2008;51:1061–7.PubMedCrossRef
17.
Goldstone SE, Winkler B, Ufford LJ, Alt E, Palefsky JM. High prevalence of anal squamous intraepithelial lesions and squamous-cell carcinoma in men who have sex with men as seen in a surgical practice. Dis Colon Rectum. 2001;44:690–8.PubMedCrossRef
18.
Palefsky JM, Holly EA, Ralston ML Arthur SP, Jay N, Berry JM, et al. Anal squamous intraepithelial lesions in HIV-positive and HIV-negative homosexual and bisexual men: prevalence and risk factors. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;17:320–6.PubMed
19.
Perkowski PE, Sorrells DL, Evans JT, Nopajaroonsri C, Johnson LW. Anal duct carcinoma: case report and review of the literature. Am Surg. 2000;66:1149–52.PubMed
20.
Jensen SL, Shokouh-Amiri MH, Hagen K, Harling H, Nielsen OV Adenocarcinoma of the anal ducts. A series of 21 cases. Dis Colon Rectum. 1988;31:268–72.PubMedCrossRef
21.
Wolff P, Peiffert D. In regard to Joon et al. IJROBP 1999;45:1199–1205. Int J Radiat Oncol Biol Phys. 2001;49:1517.
Metadata
Title
Abdominal Perineal Resection Improves Survival for Nonmetastatic Adenocarcinoma of the Anal Canal
Authors
Nicole Kounalakis, MD
Avo Artinyan, MD
David Smith, PhD
Pablo Mojica-Manoso, MD
Benjamin Paz, MD
Lily L. Lai, MD
Publication date
01-05-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0392-x

Other articles of this Issue 5/2009

Annals of Surgical Oncology 5/2009 Go to the issue

Other

Stroke Volume Variation as a Predictor of Intravascular Volume Depression and Possible Hypotension During the Early Postoperative Period After Esophagectomy

Gastrointestinal Oncology

Full Robotic Left Colon and Rectal Cancer Resection: Technique and Early Outcome

Laboratory and Translational Research

Serum Matrilysin Levels Predict Outcome in Curatively Resected Colorectal Cancer Patients

Gastrointestinal Oncology

Author Reply: Patients with Familial Adenomatous Polyposis

Breast Oncology

Author Reply: Surgery in Stage IV Breast Cancer Patients: Continued Controversy

Gastrointestinal Oncology

Impact of Chemotherapy on the Accuracy of Computed Tomography Scan for the Evaluation of Colorectal Liver Metastases