Salvage-Operation beim Analkarzinom

Background: Primary treatment for anal cancer is chemoradiotherapy. A complete response can be expected in two thirds of the cases. The indication for surgical salvage therapy arises in patients with tumor progression, persistence or recurrence. Objectives: The current standard of indication for salvage surgery and approaches for the reduction of the early and late operative morbidity are presented. Materials and methods: A selective literature search and a summary of the current evidence of the secondary therapy for anal cancer with regard to indication and surgical techniques of the salvage operation were carried out. Results: Salvage surgery of anal carcinoma consists of abdominoperineal rectal extirpation with total mesorectal excision, possibly with expansion up to exenteration. Morbidity is reduced by the minimally invasive approach, myocutaneous flaps and omentoplasty. In addition to lymph node and human papillomavirus (HPV) status, the R0 situation determines the oncological prognosis. Conclusion: Salvage surgery for anal carcinoma should be performed at centers with minimally invasive colorectal and reconstructive expertise.