Are there still surgical indications in therapy of anal carcinoma?

The development of combined radio-chemotherapy according to Nigro has had a big influence on the therapy concept of the anal canal carcinoma. Due to the successful oncological treatment combined with a possible continence preservation, a rectum extirpation is rarely indicated. Surgical indications in the therapy concept of anal canal carcinoma are large, sphincter destroying tumors, treatment complications, therapy resistant progression and the therapy of lymph node- and organ metastases. In the therapy concept of the cancer of the anal margin, the local excision as a primary therapy is of central interest in the current literature. The introduction of plastic surgery in the treatment of even vast tumors leads to adequate results of the oncological and functional treatment. The abdomino-perineal rectum extirpation is exceptionally indicated for large, sphincter destroying tumors.