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Session:: ePosters-Sun225-M4: Other Neoplasia and Endoscopy

EP576 - Salvage Surgery for Anal Squamous Cell Carcinoma after Chemoradiotherapy: Short- and Long-term Outcomes from a Contemporary Single-institution Cohort

Sunday, May 10, 2026
3:03 PM - 3:08 PM ET

    ePoster Presenter(s)

  • Kallol Kumar Das Poddar, MS (he/him/his)

    Senior Registrar
    TATA MEMORIAL HOSPITAL, MUMBAI, MAHARASHTRA, INDIA
    Tata Memorial Centre, Mumbai, India
    KOLKATA, West Bengal, India

    Disclosure information not submitted.

    • Author(s)

  • AG

    ABHISHEK GANGULY, MCH

    ADHOC ASSISTANT PROFESSOR
    TATA MEMORIAL HOSPITAL
    BANGALORE, Karnataka, India

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Sulay Shah, MS

    Senior resident Department of surgical oncology
    Tata memorial Hospital , Mumbai
    Mumbai, Maharashtra, India

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Ankit Sharma, MS, MCh. Surgical Oncology (he/him/his)

    Assistant Professor
    Colorectal Division, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai
    Tata Memorial Hospital, Mumbai
    Mumbai, Maharashtra, India

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • MK

    Mufaddal Kazi, MS; M.Ch

    Associate Professor
    TATA MEMORIAL CENTRE, MUMBAI
    mumbai, Maharashtra, India

    Disclosure information not submitted.

  • AD

    Ashwin Desouza, MCh, MS, MRCSEd, DNB, FCPS, MNAMS

    Professor & Surgeon
    Tata Memorial Centre and homi BhaBha National Institute, Mumbai.
    Mumbai, Maharashtra, India

    Disclosure information not submitted.

    • Senior Author(s)

  • Avanish P. Saklani, FRCS

    Professir Robotic / colorectal
    Tata Memorial Hospital ,
    Tata Memorial hospital , Mumbai
    Mumbai, Maharashtra, India

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
ABHISHEK GANGULY, MCH: This individual has no financial relationships with ineligible companies.
Sulay Shah, MS: This individual has no financial relationships with ineligible companies.
Ankit Sharma, MS, MCh. Surgical Oncology: This individual has no financial relationships with ineligible companies.
Avanish P. Saklani, FRCS: This individual has no financial relationships with ineligible companies.
Purpose/Background: Definitive chemoradiotherapy (CTRT) is standard for anal canal squamous cell carcinoma (SCC), yet 20-30% develop residual or recurrent disease. Salvage abdominoperineal resection (APR) or pelvic exenteration (PE) remains the only curative option but carries high morbidity. This study assesses outcomes and prognostic factors of salvage surgery for residual or recurrent anal SCC after CTRT.

Methods/Interventions: A retrospective review was performed of patients undergoing salvage APR or PE for biopsy-proven residual or recurrent anal SCC after definitive CTRT (2010-2024). Demographic, clinicopathological, operative, postoperative data and long term outcomes were analyzed.

Results/Outcomes: A total of 41 patients underwent APR or PE for low rectal/anal canal SCC between 2010-2024 (mean age 54.4 ± 10.0 years; 73.2% male; median BMI 23.4 kg/m² (IQR 5.8). Residual disease was seen in 30 (73.2%) and recurrent in 11 (26.8%) patients. Median time to recurrence post CTRT was 54.57 weeks (IQR-76.5). Residual cases had more T3 primaries (22 [73.3%] vs 5 [45.5%]), while recurrent cases had more T4 (5 [45.5%] vs 4 [13.3%]), N2 (4 [36.4%] vs 5 [16.7%]), and baseline CRM involvement (7 [63.6%] vs 12 [40%]).

36 (87.8%) patients underwent APR, the rest underwent PE. Overall 24 (58.5%) were operated laparoscopically. Salvages for recurrence had a higher incidence of extended total mesorectal excisions- 72.7%, p=0.04 and a higher proportion of pelvic lymph node dissections -36%. Flap reconstruction of the defect was done in 19 (46.3%). Median blood loss was 300ml (IQR 800), median length of admission 10.5 days (IQR 9). Morbidity>=Clavien Dindo III was seen in 12 (29.2%) and perineal wound complications in 10 (24.4%) patients. 5 (12.5%) patients had empty pelvis syndrome, and 1 patient was reexplored.

The circumferential resection margin (CRM) was involved in 5 (12.5%) specimens, all were excised for residual disease. Mean specimen length was 24.8± 4.59 cm. Salvages for recurrence had a higher incidence of pT4 disease (27.3%). Rates of poorly differentiated histology and N+ disease was comparable between the groups.

At a median followup period of 25 (IQR 44.2) months, overall 15 (36.5%) patients developed recurrence, rates were comparable across both cohorts. 5 (33.3%) patients had local recurrence, 7 (46.7%) had distant failure, and 3 (20%) had both. On multivariable Cox analysis, CRM positivity (HR 3.4, CI: 1.2, 9.2) and pT>=3 (HR 2.3, CI: 0.8, 6.0) were associated with reduced disease-free survival (DFS).

3 year overall survival (OS) and DFS was higher (though not statistically significant) in the cohort who underwent salvage for recurrence (81.8% vs 70.6%, log rank=0.68) and (72.7% vs 47.6%, log rank=0.23) respectively.

Conclusion/Discussion: Patients undergoing surgery for recurrent disease showed better, though non-significant, survival than those with residual disease. CRM positivity independently predicted poorer DFS, highlighting the need for R0 resection

DISEASE FREE SURVIVAL- RECURRENCE VS RESIDUAL DISEASE COHORT POST SALVAGE SURGERY
OVERALL SURVIVAL- RECURRENCE VS RESIDUAL DISEASE COHORT POST SALVAGE SURGERY