Salvage abdominoperineal resection for anal cancer following chemoradiation: a proposed scoring system for predicting postoperative survival.

BACKGROUND AND OBJECTIVES: Anal carcinoma is treated primarily by chemoradiation. Failure of this treatment requires salvage surgery. The aims of this retrospective study were to assess the survival probability after rescue surgery and design a pathological risk score (PRS) to predict postoperative outcome. METHODS: From 1982 to 2011, the clinical and pathological data of 111 patients treated with chemoradiation or radiation alone and abdominoperineal resection were reviewed. The Kaplan-Meier method was used to assess overall survival and parametric modeling was applied to determine prognostic factors and design a PRS. RESULTS: The 2- and 5-year overall survival rates were 60% and 24.5%, respectively. The multivariate analysis showed that nodal disease (P < 0.03), resection margin (P < 0.001), and perineural and/or lymphovascular invasion (P < 0.0001) were significantly associated with survival. Patients who presented negative values for these three variables were estimated to show a 5-year survival rate of 55% compared with 0.03% for patients who presented positive values. CONCLUSIONS: Positive surgical margin, the presence of perineural and/or lymphovascular invasion and positive nodal involvement were identified as significant independent predictors of mortality. The PRS was shown to be highly predictive of postoperative outcome.

Lymph Nodes Number in Surgical Specimen Modifies Prognosisin Advanced Stage Gastric Cancer Patients– Study of the Will-Rogers Phenomenon

Background: The AJCC 2002 staging system recommends the study of at least 15 lymph nodes in the surgical specimen. Thisnumber varies and sometimes it is not achieved since it is influenced by surgeons, pathologists and patients and may modifythe patient’s staging and survival. Methods: This is an observational study of 201 patients with gastric cancer submitted tosurgery in the period of January 1997 to December 2001, and followed-up until July 2003 in the Brazilian National CancerInstitute. Data related to surgeon and pathologist productivity as well as survival were analyzed. Results: All patients that haveundergone D2 lymphadenectomy had more than 15 lymph nodes. The factors related to varied number of lymph nodes were:surgeon (31.5±9.3 to 43.8 ±16.8); surgical procedure (total gastrectomy, 41.4 ±15.5); extended resection (40.8 ±15.9);pN3 and stage IV (55.1 ±15.8). Multivariate analysis showed the surgeon as an independent variable (p=0,02). The morelymph nodes studied, the more nodal metastasis found (p=0.01), but this fact has been significant only in pT3 patients(p=0.007). The variables related to survival have been surgical procedure, resection of another organ, site of the tumor; pT andpN. The independent variables have been pT (p=0,01) and pN (p=0,004). Conclusion: The surgeon’s technique is the mainfactor related to number of lymph nodes in the surgical specimen and for accurate staging of pT3 patients over 30 lymph nodesarenecessary.