Wide resection and reconstruction preserving fecal continence in recurrent anal cancer

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Abstract
A new operation was developed to treat patients with local recurrence of cancer at the anal margin after radiotherapy. This operation aims at resection of the tumor with oncologically safe margins, preservation of fecal continence, and reliable wound healing. After intensive radiotherapy, three patients with local recurrences of squamous-cell carcinoma of the anus refused to undergo abdominoperineal resection. These patients were treated by wide local excision and primary reconstruction. Wide local excision included perianal skin with subcutis and the anal canal including the internal sphincter up to the dentate line. To reconstruct the anus, the rectum was mobilized and brought down to the level of the perineum through the external sphincter and anastomosed to bilateral biceps femoris myocutaneous flaps. In the first three patients no tumor recurrences have occurred, and fecal continence has been good. The first results with this continence-preserving operation in patients with recurrent anal margin cancers after radiotherapy have been encouraging.

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