Background: Although squamous cell carcinoma of the anus (SCCA) is a relatively uncommon malignancy in the United States, it continues to increase in incidence. Treatment for locoregional disease includes mitomycin and 5-fluorouracil with radiation. This combination is associated with significant toxicity, limiting its use in patients who are older or have certain comorbidities. Carboplatin and paclitaxel (C/P) is an accepted treatment regimen for metastatic SCCA. We aim to evaluate the efficacy and toxicity of weekly C/P given with radiation for patients unable to receive standard chemoradiation for SCCA. Methods: From our cancer registry, adult patients who received weekly intravenous C/P concurrent with standard-dose radiation for localized SCCA were included in this study. Clinical response was determined based on the evidence of disease on imaging and/or anoscopy. Toxicities were graded according to the CTCAE v5. Results: Ten patients were included; eight were female, and the median age was 75.5 years (54–87). Six had T2 disease, and four had T3 tumors. Four had node-positive disease. The majority (70%) of patients were dosed at standard C (AUC 2) and P (50 mg/m²), with a limited subset requiring dose reduction for baseline performance status. Patients completed a mean of 78.3% (40–100%) of the intended treatments. A total of 89% of the patients achieved a complete clinical response. With a median follow-up of 25.8 months (3.4–50.4 months), 67% of the patients are alive and without recurrence. Two patients have had local recurrence, and one patient had metastatic progression. The most common toxicities of any grade included leukopenia (100%), anemia (100%), radiation dermatitis (100%), diarrhea (100%), and fatigue (100%). Grade 3 or higher toxicities included neutropenic fever (20%), neutropenia (30%), and anemia (30%). Conclusions: This study demonstrates promising tolerability and efficacy for weekly C/P chemoradiation for patients with anal cancer unable to receive mitomycin and 5-fluorouracil. This regimen merits further investigation in prospective clinical trials.

Background: Robot-assisted surgery has expanded in adoption and indication among multiple surgical specialties, including colorectal surgery. It is unclear if access to robotic surgery is increasing equally among all patient populations. Objective: (1) Identify the factors that may influence type of surgical approach and (2) evaluate disparities in access and subsequent outcomes of colectomy and proctectomy from years 2013–2020 using a national database. Study design: We performed a retrospective study using the National Surgical Quality Improvement Program to identify adult patients who had undergone colectomy and/or proctectomy from years 2013–2020. We performed multivariate analysis to identify factors that may influence the likelihood of receiving robotic surgery. Settings: Tertiary care medical center. Patients: 18 years and older, received colectomy and/or proctectomy from 2013–2020. Main outcome measures: Frequency of robotic colorectal surgery, postoperative complications, and mortality. Results: A total of 125,776 patients met inclusion criteria. Mean age was 61.4 years; 12.8% (16,086) of patients were non-White. In multivariate analysis, patients who were female, non-White, underweight or had inflammatory bowel disease were less likely to undergo robot-assisted surgery (p < 0.05). Although the total number of robotic cases increased year-to-year, the gap between White and non-White patients widened. In 2014, a White patient was 1.51 times more likely to have robot-assisted surgery compared to a non-White patient; odds increased to 1.96 in 2020 (p < 0.001). Patients who underwent robot-assisted surgery were less likely to have a postoperative complication (OR 0.86, CI 0.82–0.9) or serious adverse event (OR 0.9, CI 0.84–0.97), and had lower odds of 30-day mortality (OR 0.72, CI 0.57–0.91). Limitations: Retrospective, limited coding in national databases, and database variables. Conclusions: Despite increased awareness of racial and ethnic disparities in surgical care, non-White patients’ decreased access to robot-assisted surgery is troublesome. Interventions must focus on closing this gap if we are to provide equitable healthcare.