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Salvage abdominoperineal resection for anal squamous cell carcinoma: a systematic review and meta-analysis of proportions

Phase meta-analysisN = 1,013

Population
Adults with persistent or recurrent anal squamous cell carcinoma who had salvage abdominoperineal resection after failure of chemoradiotherapy
Design
Systematic review of observational studies of adult patients with persistent or recurrent anal squamous cell carcinoma who had salvage abdominoperineal resection after chemoradiotherapy failure, searched in PubMed, Scopus and Cochrane through March 2026. Binary outcomes were pooled as proportions on the logit scale under random-effects models (a generalized linear mixed model when zero-event studies were present). 18 observational studies with 1,013 patients were included.
Arms
  • Salvage abdominoperineal resection (experimental): Salvage abdominoperineal resection after failure of chemoradiotherapy; observational studies, no comparison group
People
Belfort GR, senior author Formiga FB
Show the numbers
Results reported for Salvage abdominoperineal resection for anal squamous cell carcinoma: a systematic review and meta-analysis of proportions
EndpointAnalysisSalvage abdominoperineal resectionControlEffect
OSPooled observational studies (18 studies, 1,013 patients in the review)primaryBelfort 202668.34% at 2 y (60.42–75.33%); 46.43% at 5 y (38.03–55.04%)—Pooled 2-year and 5-year overall survival after salvage APR (random-effects pooled proportions). Heterogeneity I2 = 65% and 81% respectively.
DFSPooled observational studies (18 studies, 1,013 patients in the review)primaryBelfort 202650.36% at 3 y (20.62–79.85%); 41.79% at 5 y (27.80–57.24%)—Pooled 3-year and 5-year disease-free survival after salvage APR. Heterogeneity I2 = 95% and 90% respectively.
Locoregional failurePooled observational studies (18 studies, 1,013 patients in the review)Pooled locoregional recurrence rate after salvage APR.primaryBelfort 202634.03% (27.22–41.57%)—Pooled locoregional recurrence (I2 = 72%). The pooled overall recurrence rate was 44.28% (95% CI 36.63-52.21; I2 = 79%) and distant recurrence 17.39% (12.24-24.13; I2 = 83%).
Major postoperative complicationsPooled observational studies (18 studies, 1,013 patients in the review)Major complications graded Clavien-Dindo III or higher; pooled proportion.primaryBelfort 202627.97%—Pooled proportion of major complications (Clavien-Dindo III or higher); overall morbidity was 50.70%. Pooled R0 and R1 resection rates were 79.71% and 17.08%. The abstract gives no confidence interval for these proportions.
30-day mortalityPooled observational studies (18 studies, 1,013 patients in the review)primaryBelfort 20261.18% (0.36–3.85%)—Pooled 30-day mortality after salvage APR (I2 = 0%).
Results reported for Salvage abdominoperineal resection for anal squamous cell carcinoma: a systematic review and meta-analysis of proportions
EndpointAnalysisSalvage abdominoperineal resectionControlEffect
OSPooled observational studies (18 studies, 1,013 patients in the review)primaryBelfort 202668.34% at 2 y (60.42–75.33%); 46.43% at 5 y (38.03–55.04%)—Pooled 2-year and 5-year overall survival after salvage APR (random-effects pooled proportions). Heterogeneity I2 = 65% and 81% respectively.
DFSPooled observational studies (18 studies, 1,013 patients in the review)primaryBelfort 202650.36% at 3 y (20.62–79.85%); 41.79% at 5 y (27.80–57.24%)—Pooled 3-year and 5-year disease-free survival after salvage APR. Heterogeneity I2 = 95% and 90% respectively.
Locoregional failurePooled observational studies (18 studies, 1,013 patients in the review)Pooled locoregional recurrence rate after salvage APR.primaryBelfort 202634.03% (27.22–41.57%)—Pooled locoregional recurrence (I2 = 72%). The pooled overall recurrence rate was 44.28% (95% CI 36.63-52.21; I2 = 79%) and distant recurrence 17.39% (12.24-24.13; I2 = 83%).
Major postoperative complicationsPooled observational studies (18 studies, 1,013 patients in the review)Major complications graded Clavien-Dindo III or higher; pooled proportion.primaryBelfort 202627.97%—Pooled proportion of major complications (Clavien-Dindo III or higher); overall morbidity was 50.70%. Pooled R0 and R1 resection rates were 79.71% and 17.08%. The abstract gives no confidence interval for these proportions.
30-day mortalityPooled observational studies (18 studies, 1,013 patients in the review)primaryBelfort 20261.18% (0.36–3.85%)—Pooled 30-day mortality after salvage APR (I2 = 0%).
Illustrative — modelled from reported values, not trial data. OS, primary.
0%25%50%75%100%0102030405060Months (modelled)
  • Salvage abdominoperineal resection (experimental)
Data table (modelled values)
MonthsSalvage abdominoperineal resection
0100.0%
1677.6%
3261.8%
4952.3%
6546.4%
Illustrative — modelled from reported values, not trial data. DFS, primary.
0%25%50%75%100%0102030405060Months (modelled)
  • Salvage abdominoperineal resection (experimental)
Data table (modelled values)
MonthsSalvage abdominoperineal resection
0100.0%
1675.9%
3254.3%
4944.3%
6541.8%
Primary publication: Belfort GR, Pompeu BF, Velucci MP, Baptista CH, Delgado LM, Marques FILCB, et al. Salvage abdominoperineal resection for anal squamous cell carcinoma: A systematic review and meta-analysis of proportions. Colorectal Dis. 2026;28(7):e70543. PubMedDOI

Appears in

Sources

  1. Belfort GR, Pompeu BF, Velucci MP, Baptista CH, Delgado LM, Marques FILCB, et al. Salvage abdominoperineal resection for anal squamous cell carcinoma: A systematic review and meta-analysis of proportions. Colorectal Dis. 2026;28(7):e70543.

    PubMedDOI