eP313 - Clinico-demographic Characteristics of Patients Undergoing Surgery for Anal Cancer

Sunday, June 2, 2024

10:45 AM – 10:50 AM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Anyelin Almanzar Hirujo, MD

Fellow
Medstar Washington Hospital Center
Medstar Washington Hospital Center
Washington, DC, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

Majed El Hechi, MD

Resident Physician
MedStar Georgetown University Hospital
MedStar Georgetown University Hospital
Washington, DC, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Timothy J. Holleran, MD

Resident Physician
MedStar Georgetown University Hospital
Washington, DC, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Jacob M. Broome, MD

Resident Physician
Medstar Georgetown Washington Hospital Center
Georgetown Washington Hospital Center
20009, DC, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Brian L. Bello, MD

Division Chief
Department of Colon & Rectal Surgery, MedStar Washington Hospital Center
MedStar Washington Hospital Center
Washington, District of Columbia, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

SB

Sara Berkey, MD

Colon and Rectal Surgeon
Medstar Health
Washington, District of Columbia, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
PA

Preetha Ali, MD

Colon & Rectal Surgeon
Medstar Washington Hospital Center
Washington, District of Columbia, United States

Disclosure information not submitted.
ZS

Zhifei Sun, MD

Assistant Professor of Surgery
MedStar Georgetown University Hospital
Falls Church, Virginia, United States

Disclosure information not submitted.
AF

Anne Fabrizio, MD

Colorectal Surgeon
Medstar Georgetown University Hospital
Washington, District of Columbia, United States

Disclosure information not submitted.

Purpose/Background: Anal cancer is an uncommon entity accounting for 2.5% of gastrointestinal malignancies. Currently, standard of care involves chemotherapy and radiation followed by abdominoperineal resection for persistent or recurrent disease. While not a formal recommendation, there are several patients who instead undergo local excision. Our objective is to explore the patient characteristics between those who get local excision versus abdominoperineal resection.Methods/Interventions: Retrospective of National Cancer Database including patients diagnosed with anal cancer and had received chemoradiation between 2016-2020 was conducted. The primary endpoint was the comparison of clinicodemographic characteristics and outcomes of patients who underwent local excision versus abdominoperineal resection. Secondary endpoint was the comparison of clinicodemographic characteristics between patients who ultimately required surgery versus those who did not.Results/Outcomes: A total of 14,238 were included. Of those, 9,870 (69.3%) were female. Median age was 62 (IQR 55-70). 12,268 (86.2%) were White, 1,521 (10.7%) African American and 308 (2.2%) Asian. Overall, 10, 842 patients (76.1%) did not undergo surgery versus 3,396 (23.9%) who did. Those who did not undergo surgery were more likely to have positive lymph nodes than those who underwent surgery (46.9% vs 25.8%). On multivariable analysis, as compared to patients who did not undergo surgery, patients who underwent surgery were more likely to be black (OR 1.28, [1.1-1.5], p=0.001) or Hispanic (OR 1.30, [1.05-1.59], p=0.013). These patients were also less likely to be male (OR 0.68, [0.61-0.74], p=0.001) and have stage 2 (OR 0.28, [0.25-0.31], p=0.001) or stage 3 (OR 0.14, [0.10-0.19], p=0.01) disease. There was no difference regarding insurance status, percentage of patients with high school degree, median income quartiles, urban or rural setting, treating facility, Charlson-Deyo score or days to treatment initiation. Patients who had surgery were further divided into those who underwent local excision vs abdominoperineal resection. Those who underwent local excision were more likely to have well differentiated (21.4% vs 12.9%), but patients who underwent surgery were more likely to obtain negative resection margins (81.7% vs 45.5%). On multivariable analysis, as compared to patients who underwent local excision, patients who underwent abdominoperineal resection were more likely to be treated at a comprehensive cancer center (OR 1.4, [1.05-1.76], p=0.02) and have Stage II (OR 4.5, [3-6.8], p=0.001) or Stage III disease (OR 25.7, [12.9-50.9], p=0.01). These patients were also less likely to be male (OR 0.73, [0.56-0.94], p=0.018) and have positive lymph node status. There was no difference regarding race, unplanned readmission as well as 30- and 90-day mortality.Conclusion/

Discussion: Black and Hispanic patients, as well as females, are more likely to undergo surgery following chemoradiation for anal cancer. Further studies are needed to elucidate causality. Patients who undergo local excision are more likely to have well-differentiated tumors, stage I disease, negative lymph node status and higher positive margins.