Surgical treatment for patients with persistent and recurrent squamous cell anal carcinoma

AIM: to evaluate the oncological and surgical results of the treatment in patients with recurrent squamous cell anal carcinoma (SCAC) after CRT and to identify prognostic factors of overall survival (OS).

PATIENTS AND METHODS: patients who underwent abdominoperineal resection (APR) between January 2013 to December 2024 for persistent or recurrent squamous cell carcinoma of the anal canal after CRT were retrospectively analysed in a single-centre study. The early and long-term outcomes, recurrence and incomplete response to CRT were compared. The primary endpoint was overall survival (OS). Additionally, the disease-free survival (DFS), the R0 resection rate, post-op complications, risk factors, second recurrence after APR were evaluated.

RESULTS: sixty-one patients underwent APR, of which 34 (55.7%) had a recurrence and 27 (44.3%) had an incomplete response to CRT. The median follow-up was 35.9 months (95% CI: 25.3–46.6). The overall 3-year survival rate was 66.5% (95% CI 54.0–81.9%). The 3-year OS was 74.0% for relapses (95% CI 59.3–93.0%) and 56.4% for incomplete response to CRT (95% CI 37.9–84.0%). The differences in OS were unreliable (HR 1.8; 95% CI: 0.7–4.6; p = 0.2). The 3-year DFS was 55.4% (95% CI 43.2–71.1%). Three-year DFS was 63.1% (95%CI 47.4–83.7%) for relapses and 46.1% (95% CI 29.2–72.5%) for incomplete response to CRT. Differences in DFS were unreliable (HR 1.70; 95% CI: 0.7–4,5%; p = 0.18). Ten (16.1%) patients developed distant metastases after surgery. Sixteen (47.1%) patients developed local recurrence after APR, 2 (12.5%) of them underwent salvage re-operation and another two of them (12.5%) underwent repeated radiation therapy. Seven (43.7%) out of 16 patients received palliative chemotherapy. The remaining 5/16 (31.3%) patients received symptomatic treatment. The median age of patients with recurrent relapse was 23.9 (95% CI 23.7–24.1) months. R0 resection was performed in 55 (90.30%) patients. OS was significantly reduced by incomplete response of the primary tumor to CRT (HR 2.7; 95% CI: 0.98– 7.92; p = 0.05) and violation of the CRT regimen (HR 2.8; 95% CI: 1.03–7.62; р = 0.04).

CONCLUSION: surgical treatment of recurrent SCAC is associated with a high risk of second recurrence, but remains the only potentially curative option for this category of patients. It is necessary to find ways to improve local disease control during surgical treatment.

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