Trends in Primary Surgery and Overall Survival in Non-Metastatic Anal Cancer: A Population-Based Analysis

In this population-based study, primary surgery for non-metastatic anal cancer declined substantially over time, while overall survival improved, supporting the continued shift toward CRT-first, sphincter-preserving management. These findings reinforce the importance of guideline-concordant, multidisciplinary care and careful response assessment before considering surgery. Persistent use of upfront surgery in select subgroups suggests a need for closer evaluation of treatment decision-making, patient counseling, and potential barriers to optimal nonsurgical therapy.