To the Editor Using the National Cancer Data Base, Chai et al1 analyzed arguably the largest cohort of early-stage (T1N0) squamous cell carcinoma of the anal canal in the literature and concluded that local excision may be a treatment option in these patients. We strongly urge caution regarding this interpretation and remind the readership that the European Society for Medical Oncology–European Society of Surgical Oncology–European Society for Radiotherapy and Oncology guidelines2 consider this approach to be contraindicated.
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Renehan AG, Muirhead R, Sebag-Montefiore D. Limitations of the National Cancer Data Base to Evaluate Early-Stage Anal Cancer Treatment Outcomes. JAMA Surg. 2018;153(7):691. doi:10.1001/jamasurg.2018.0394
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