Outcomes of radiofrequency ablation for anal high-grade squamous intraepithelial lesions

BACKGROUND

Radiofrequency ablation (RFA) of high-grade squamous intraepithelial lesions (HSIL) is a promising minimally invasive technique but its oncologic and functional outcomes are not well studied. The primary outcome was the efficacy of RFA, and the secondary outcomes were the functional and anatomical anal changes related to RFA.

METHODS

This was a retrospective analysis of our prospectively collected database of patients who had RFA for HSIL at our institution, between August 2018 and March 2020. To be eligible for RFA, all patients had impairment of their immune function. Targeted ablation was applied in all cases, with 5 overlapping pulsations at the targeted HSILs (delivering 12 J/cm² per application) followed by circumferential, 2-pulsation (12 J/cm²) overlapping anal ablation, to cover the entire anal transition zone. Patients were assessed for recurrence or metachronous disease at 3-month intervals by means of high-resolution anoscopy (HRA) and targeted biopsies. Anorectal manometry, endoanal ultrasound, the 36-Item Short Form and Massachusetts General Hospital-Sexual Functioning Questionnaire (MGH-SFQ) were assessed at baseline and 12 months after intervention.

RESULTS

We included a total of 12 patients with anal HSILs. The mean age was 38.6 (± 7.68) years, and 7 (58.3%) were males. Six were HIV positive, 2 had a primary immunodeficiency disease, and 4 were receiving immunosuppressive therapy. A mean of 2.1 anal HSILs per patient were treated. At 12 months, high-resolution anoscopy showed that 7/12 (58.3%) patients had normal high-resolution anoscopy, 3/12 patients had recurrent HSILs, and 2/12 had a persistent lesion. Those lesions were treated with electrocautery, and reached complete response in the following the 6 months (total of 18 months). In particular, there were no metachronous lesions detected. Patients reported moderate to severe pain during the first 24 h after RFA, but only mild discomfort was present at 30 days. Patients were asymptomatic at their 6- and 12-month visits. RFA was not associated with changes in anorectal manometry or ultrasound examination. The 36-SF survey reported improvement in the general health domain (p = 0.038), while the MGH-SFQ showed improvements in sexual function.

CONCLUSIONS

In this study, targeted plus circumferential RFA had a 58.3% efficacy rate for the treatment of anal HSIL in immunocompromised patients, achieving 100% eradication after adding electrocautery ablation. No metachronous lesions were detected. Patients presented relatively mild symptoms after the procedure, no changes in anorectal anatomy or function, and some improvements in their sexual function. These results seem promising in light of the high recurrence reported after HSIL treatment. Larger studies are needed to validate our results.

Surgical treatment of giant anal condyloma in HIV patients: unanswered questions

We are writing to comment on the article by Uribe et al., "Management on giant anal condyloma by wide local excision and anoplasty". [1] Anogenital warts are among the most common sexually transmitted diseases seen in surgical practice, they are found in up to 1.7% of the general population, but in HIV population, they range from 3 to 24.9%. It is important to realise that 78% of patients with external anogenital warts have internal lesions as well although they are unlikely to be proximal to the dentate line. [2] This article is protected by copyright. All rights reserved.

Colonic cavernous hemangiomas: a report of two cases treated by laparoscopic surgery

Hemangiomas are rare vascular tumors. They most commonly appear in the small bowel, as well as the colon and the rectum. Here, we report two cases of male patients who were admitted to our hospital for low rectal painless bleeding, misdiagnosed of hemorrhoid bleeding. Colonoscopy reported vascular tumors in both cases, which we surgically removed.

Colorectal cancer surgery in elderly patients: presentation, treatment, and outcomes

PURPOSE

This study was designed to characterize the presentation, care, and outcomes of persons older than 75 years, compared with persons 50 to 74 years of age, selected for colorectal cancer.

METHODS

Patients over the age of 50 years who had surgery for colon or rectal cancer at the Mount Sinai Hospital between 1997 and 2006 were identified. Data were obtained from a colorectal cancer database and from office and hospital records. Patients were assigned to two groups: 50 to 74 years old and 75 years and older.

RESULTS

There were 623 patients in the younger group (mean age, 62.6 years) and 275 in the older group (mean age, 81.5 years). The in-hospital mortality rate was 1% in the younger group compared with 4.2% in the older (P = 0.002). The overall five-year survival was 68.7% and 57.3% in the younger and older groups, respectively, whereas colorectal cancer-specific five-year survival was not significantly different (74.0% vs. 74.7%). There were significant differences between the two groups with respect to cancer location, American Society of Anesthesiologists' score, stage, proportion detected by screening, length of stay, and use of chemotherapy.

CONCLUSIONS

Long-term colorectal cancer-related outcomes in the older group are similar to the outcomes in younger patients, suggesting that the decision to operate should not be based on age alone.