Combined Resection for Anal Cancer
The term ‘combined resection” refers to removing the primary cancer and one or a few metastatic area, in the hope that there are no metastases and that it will lead to a cure or prolonged period of being free of cancer. While a combined resection of rectal cancer and partial liver resection of metastases is well established, the same is not the case for anal cancer. Metastatic anal cancer is not well studied in regard to a combined resection. NCCN recommends only 5FU and cisplatin or cisplatin for metastatic anal cancer. A recent review states: ” Metastatic disease develops in 10%–17% of patients treated with chemoradiation therapy. The most common site of distant metastasis is the liver. There are limited published data on the use of chemotherapy, particularly newer agents, to treat metastatic anal carcinoma. Active agents include cisplatin plus 5-FU, carboplatin, doxorubicin, and semustine. Participation in a clinical trial should be discussed with all potentially eligible patients.”
Although there have been no randomized trials comparing surgery with radiation treatment or with combined chemoradiation, based on multiple studies and clinical experience for the last 20 years, there has been a substantial change in the management of epidermoid anal carcinomas, with more patients undergoing nonsurgical treatment.
I was not able to find credible literature supporting a combined resection approach for anal cancer. NCCN lists only 5 Fu and cisplatin for metastatic anal cancer therapy. The first report of this approach was a case report by Tokar in 2006 and no prospective trials have been reported.
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