Management of persistent or locally recurrent epidermoid cancer of the anal canal with abdominoperineal resection

We retrospectively evaluated the outcome of 22 patients with epidermoid can cer of the anal canal who underwent surgical salvage after failure of prima ry chemoradiotherapy. Patients who required surgery had significantly more advanced T-stage than those who did not fail chemoradiotherapy. Eighteen pa tients failed surgical salvage. Invasion through the muscle wall of the bow el was present in 16 of 18 patients compared with two of four patients who have no evidence of disease (follow-up 5-10 years). Failure occurred only i n the pelvis in 13 of the patients who died of disease. The mean time to de ath after surgery was 19 months. We confirm the overall poor results of con ventional abdominoperineal resection in those patients who have Failed prev ious therapy. Most failures occur in the pelvis. Transanorectal ultrasound and magnetic resonance imaging (MRI) may allow better selection of patients for exenterative procedures and identify those not amenable to successful salvage.