Multidisciplinary salvage surgery for anal cancer - clear margins come at a cost: P113

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Aim:To assess short-term outcomes after multidisciplinary salvage surgery for anal cancer following radical chemo-radiotherapy in light of service centralisation.Method:Patients requiring salvage surgery for anal cancer were identified from aprospective electronic database between Dec 2007and Nov 2009.Results:Ten patients (five male) underwent salvage surgery. Median age was 54 years. Indications for surgery included adenocarcinoma (n = 1); squamous cell carcinoma (five recurrence, three persistent disease, oneprimary surgery). Eightprocedures were complex, including en bloc vaginectomy/hysterectomy (n = 3), cystoprostatectomy (n = 1), coccygectomy (n = 1), synchronous liver resection (n = 1) and inguinal lymph node dissection (n = 2). Eight patients required pedicled flap reconstruction (two VRAM; three gluteal fold; three gracilis). Median blood loss was 630 (350- 1400) mls. Median operative time was 555 (445-870) min. R0 resection margins were achieved in all cases. Complications occurred in eight patients (five flap-related). Thirty day and in-hospital mortality was zero. Median length of stay was 37 (6-84) days.Conclusion:Salvage surgery for anal cancer often requires complexprocedures involving several surgical specialties. Clear resection margins can be achieved with en bloc or multivisceral resection. Operating times are long, and theprocedures are associated withprolonged hospital stay and significant morbidity.Centralisation will facilitate careful analysisoflong-termoncological and functional outcomes.

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