Outcome after surgical resection for high-grade anal intraepithelial neoplasia (Bowen's disease)

Background: High-grade anal intraepithelial neoplasia (Bowen's disease) may predispose to anal carcinoma. Treatment options include surgical resection but effectiveness remains uncertain. This paper reports long-term follow-u p of patients with high-grade anal intraepithelial neoplasia treated by sur gical resection. Methods: Between 1989 and 1996, 46 patients were identified with high-grade anal intraepithelial neoplasia. Thirty-four underwent local excision of al l macroscopically abnormal disease and the resulting defect was left open, closed primarily or skin grafted. Regular follow-up subsequently included a noscopy and biopsy of any suspicious lesions. Results: Median follow-up was 41 (range 12-104) months. Total excision was difficult; 19 patients had histological evidence of incomplete excision at the time of initial resection. Some 12 of 19 had histologically proven recu rrent high-grade intraepithelial neoplasia within 1 year. Even with microsc opically complete excision two of 15 patients subsequently developed recurr ent high-grade intraepithelial neoplasia at 6 and 32 months after operation . No patient developed carcinoma but five had complications of anal stenosi s or faecal incontinence. Conclusion: Although no definite recommendations can be made for the treatm ent of high-grade anal intraepithelial neoplasia, these results illustrate some potential drawbacks of surgical excision with a high potential for inc omplete excision and persistent disease, even after complete excision in so me patients, and a high morbidity rate.