We report an aggressive case of anal cancer recurrences.
This 38-year-old male presented with extensive verrucous
anal carcinoma extending laterally across both buttocks. He
was diagnosed in May 2019 with a T3N1cM0 anal SCC. His
initial treatment entailed four cycles of neoadjuvant chemotherapy
with carboplatin and paclitaxel, completed in
October 2019, preceded by a laparoscopic defunctioning
loop colostomy. Subsequent radical chemo radiotherapy using
53.2 Gy in 28 fractions with concurrent mitomycin C and
capecitabine was complete in January 2020. MRI pelvis and
PET CT scan 5 months later demonstrated total resolution,
supported by an equally promising clinical response. However,
further follow-up imaging at ten months post completion
of treatment, suggested local disease recurrence with
prominent FDG avid internal iliac lymph node, correlating
with clinical findings. He underwent an extended ELAPE followed
by VRAM myo-cutaneous flap with unilateral V-Y advancement
flap on right side and fascio-cutaneous rotation
advancement flap on left side. Recovery was complicated
by wound dehiscence, successfully managed by a negative
pressure dressing. He remains well and disease free.