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Long-term oncological outcomes after salvage surgery for anal squamous cell carcinoma – a national cohort study

Jacobsen, Stephanie LU ; Angenete, Eva ; Johnsson, Anders ; Lydrup, Marie-Louise LU ; Nilsson, Per J. and Buchwald, Pamela LU (2026) In European Journal of Surgical Oncology 52(4).
Abstract
Introduction
Anal squamous cell carcinoma (ASCC) is an HPV-related tumor primarily treated with concurrent chemoradiotherapy (CRT). Salvage surgery is reserved for patients with residual or recurrent disease following CRT, representing a highly selected, high-risk subgroup. Population-based data on outcomes and prognostic factors after salvage surgery are limited. This study aimed to assess overall survival (OS) and identify prognostic factors in a centralized, national cohort to inform clinical decision-making.
Methods
Data were retrospectively collected from the Swedish anal cancer registry and medical charts of all ASCC patients undergoing salvage surgery in Sweden between 2017 and 2021. Survival was analyzed using... (More)
Introduction
Anal squamous cell carcinoma (ASCC) is an HPV-related tumor primarily treated with concurrent chemoradiotherapy (CRT). Salvage surgery is reserved for patients with residual or recurrent disease following CRT, representing a highly selected, high-risk subgroup. Population-based data on outcomes and prognostic factors after salvage surgery are limited. This study aimed to assess overall survival (OS) and identify prognostic factors in a centralized, national cohort to inform clinical decision-making.
Methods
Data were retrospectively collected from the Swedish anal cancer registry and medical charts of all ASCC patients undergoing salvage surgery in Sweden between 2017 and 2021. Survival was analyzed using Kaplan-Meier estimates, log-rank tests, and Cox proportional hazards regression.
Results
Seventy-seven patients underwent salvage surgery with curative intent for residual (n = 34) and recurrent (n = 43) disease. Median age was 64 (IQR 56-73) years, 54 (79%) were HPV-positive and 7 (9%) underwent total pelvic exenteration. R0-resection was achieved in 66 patients (86%), with a 5-year OS of 67.4%, compared with 9.1% for R1-resections (HR 6.16, 95% CI 2.80-13.58). Median follow-up was 46 (IQR 22-65) months. Other factors associated with OS included major 30-day surgical complications (HR = 2.17, 95% CI 1.04-4.54), lymphovascular invasion (HR 2.89, 95% CI 1.25-6.67) and histologically confirmed lymph node metastasis (HR 2.33, 95% CI 1.11-4.86). HPV-status was not associated with survival.
Conclusion
This population-based study shows that long-term survival after salvage surgery is achievable when R0-resection is obtained. Importantly, major postoperative complications were identified as a novel prognostic factor in ASCC. Optimizing R0-resection rates and minimizing complications are key to improving long-term outcomes. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Surgical Oncology
volume
52
issue
4
article number
111482
publisher
Elsevier
external identifiers
  • pmid:41740517
  • scopus:105034579766
ISSN
1532-2157
DOI
10.1016/j.ejso.2026.111482
language
English
LU publication?
yes
id
b7da7c58-c8d7-4096-8040-d3dd3870e2b4
date added to LUP
2026-06-01 12:32:26
date last changed
2026-06-02 04:00:46
@article{b7da7c58-c8d7-4096-8040-d3dd3870e2b4,
  abstract     = {{Introduction<br/>Anal squamous cell carcinoma (ASCC) is an HPV-related tumor primarily treated with concurrent chemoradiotherapy (CRT). Salvage surgery is reserved for patients with residual or recurrent disease following CRT, representing a highly selected, high-risk subgroup. Population-based data on outcomes and prognostic factors after salvage surgery are limited. This study aimed to assess overall survival (OS) and identify prognostic factors in a centralized, national cohort to inform clinical decision-making.<br/>Methods<br/>Data were retrospectively collected from the Swedish anal cancer registry and medical charts of all ASCC patients undergoing salvage surgery in Sweden between 2017 and 2021. Survival was analyzed using Kaplan-Meier estimates, log-rank tests, and Cox proportional hazards regression.<br/>Results<br/>Seventy-seven patients underwent salvage surgery with curative intent for residual (n = 34) and recurrent (n = 43) disease. Median age was 64 (IQR 56-73) years, 54 (79%) were HPV-positive and 7 (9%) underwent total pelvic exenteration. R0-resection was achieved in 66 patients (86%), with a 5-year OS of 67.4%, compared with 9.1% for R1-resections (HR 6.16, 95% CI 2.80-13.58). Median follow-up was 46 (IQR 22-65) months. Other factors associated with OS included major 30-day surgical complications (HR = 2.17, 95% CI 1.04-4.54), lymphovascular invasion (HR 2.89, 95% CI 1.25-6.67) and histologically confirmed lymph node metastasis (HR 2.33, 95% CI 1.11-4.86). HPV-status was not associated with survival.<br/>Conclusion<br/>This population-based study shows that long-term survival after salvage surgery is achievable when R0-resection is obtained. Importantly, major postoperative complications were identified as a novel prognostic factor in ASCC. Optimizing R0-resection rates and minimizing complications are key to improving long-term outcomes.}},
  author       = {{Jacobsen, Stephanie and Angenete, Eva and Johnsson, Anders and Lydrup, Marie-Louise and Nilsson, Per J. and Buchwald, Pamela}},
  issn         = {{1532-2157}},
  language     = {{eng}},
  number       = {{4}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Surgical Oncology}},
  title        = {{Long-term oncological outcomes after salvage surgery for anal squamous cell carcinoma – a national cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.ejso.2026.111482}},
  doi          = {{10.1016/j.ejso.2026.111482}},
  volume       = {{52}},
  year         = {{2026}},
}