Conservative Treatment of Anal Carcinoma: The Surgeon’s View

Abstract

It is a fascinating idea to treat anal carcinoma with a multimodal therapy concept leading to preservation of the sphincter (Dunst et al. 1987; Flam et al. 1983; Nigro 1987; Pipard and Widgren 1983). This possibility is relatively new and not yet generally accepted (Schlag 1986). Even recent papers recommend other therapy modes. Notably, the different disciplines support their own concepts of the optimal treatment of anal carcinomas (Table 1). In the surgical literature the abdominoperineal rectotomy is still often considered the therapy of choice (Beahrs and Wilson 1986; Clark et al. 1986; Schraut et al. 1983), while radiologists deem radiotherapy alone sufficient (Cantril et al. 1983; Papillon et al. 1983; Puthawala et al. 1982). Even exclusive use of cytostatic drug treatment has been taken into consideration by some oncological physicians (Salem et al. 1985). The first preliminary results of a national evaluation study initiated by the Sections of Oncology (CAO) and Proctology (CAP) of the German Society for Surgery give evidence of the multitude of therapies which are at present being used in the FRG to treat anal carcinomas (Table 2). According to the study, one-third of patients are still subjected to radical surgery (rectotomy). Adjuvant therapies (radiotherapy, chemotherapy) are used to improve the local curability rather than to preserve the sphincter.