Survival outcomes following local excision compared with abdominoperineal resection after chemoradiotherapy for anal squamous cell carcinoma: An NCDB propensity score-matched analysis.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42096989.
- Also identified by DOI 10.1016/j.surg.2026.110164.
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Abstract
Although chemoradiotherapy is the standard therapy for anal squamous cell carcinoma, it unfortunately fails in 10% to 30% of patients. Abdominoperineal resection is the recommended approach for persistent or recurrent anal squamous cell carcinoma, whereas local excision is more selectively used. This study aimed to compare overall survival after local excision and abdominoperineal resection after chemoradiotherapy in patients with anal squamous cell carcinoma. This retrospective cohort study assessed patients with stage I-III anal squamous cell carcinoma from the US National Cancer Database from 2004 to 2020. Patients undergoing local excision or abdominoperineal resection after chemoradiotherapy were propensity score-matched 3:1 to balance baseline confounders. The primary outcome was 5-year overall survival. Secondary outcomes were surgical margin status, 90-day mortality, and 30-day readmission. 8,244 of 9,137 patients 8,224 (90%) underwent local excision and 913 (10%) underwent abdominoperineal resection. After matching, 392 patients undergoing abdominoperineal resection were matched to 1,176 individuals having local excision. The 5-year overall survival was significantly higher after local excision than after abdominoperineal resection (75 vs 46.1%; P < .001). This survival benefit persisted after stratification by clinical stage, tumor size, and tumor grade. Multivariable Cox regression of the unmatched cohort demonstrated that abdominoperineal resection was associated with an increased mortality risk (hazard ratio [HR], 2.94; 95% CI, 2.49-3.47; P < .001). Local excision had higher positive-margin rates (66.6 vs 25.1%; P < .001), but lower 90-day mortality (0.9 vs 5.1%; P < .001) and unplanned 30-day readmission (1.5 vs 7.7%; P < .001). Despite higher rates of positive margins, local excision was associated with higher rates of overall survival and lower rates of 90-day morbidity than abdominoperineal resection.