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Compendium February 2008 (Vol 30, No 2)

Abstract Thoughts—Immunotherapy for Anal Furunculosis in Dogs

by Joseph Harari, MS, DVM, DACVS

    Immunotherapy for Anal Furunculosis in Dogs

    Klein A, Deneuche A, Fayolle P, et al. Preoperative immunosuppressive therapy and surgery as a treatment for anal furunculosis. Vet Surg 2006;35:759-768.

    Abstract: In this retrospective clinical study from a veterinary school in France, 25 dogs with anal furunculosis (perianal fistulae) were treated preoperatively with cyclosporine alone or combined with ketoconazole (group 1) or with azathioprine combined with prednisolone (group 2). Surgical excision of diseased tissue was performed. Immunotherapy did not exceed 3 months and was used to produce regression of draining tracts to permit subsequent primary surgical wound closure. Surgery consisted of diseased tissue excision, cryptectomy, and anal sacculectomy. Dogs had various stages of the condition and unilateral or bilateral lesions. Follow-up exceeded 9 months. Most (23) of the dogs were adult (7- to 8½-year-old) German shepherds. Clinical signs included perianal licking and draining tracts, lethargy, weight loss, tenesmus, dyschezia, and hemorrhage. Clinical signs disappeared or greatly improved in all dogs within 15 days of medical treatment. Postoperative recoveries were uneventful, except in two dogs with wound breakdown. The duration of hospital stay for both groups ranged from 1 to 5 days. After surgery, the dogs received analgesics (morphine, fentanyl patch, meloxicam) and a highly digestible diet. Recurrence of disease occurred in four dogs that initially (before therapy) had bilateral disease and only unilateral surgery. The authors concluded that preoperative immunotherapy and surgical excision of all diseased tissue minimize recurrence of anal furunculosis in dogs.

    Commentary: Anal furunculosis is a debilitating condition in dogs and a source of frustration to owners and veterinarians. The painful and purulent perianal inflammatory lesions are suspected to be related to anatomic and immune-mediated factors. Initial attempts to control the disease with surgery, lasers, chemicals, cautery, and cryotherapy have produced variable results and numerous complications. As an alternative to surgery, immunosuppressive therapy is often recommended to provide better clinical results and fewer complications. The expense of drugs, such as cyclosporine, for use in large, affected dogs may be a limitation for some owners. The results of this clinical study from Europe suggest that immunotherapy (with any of the protocols described) followed by surgical excision of all affected tissue provides a reasonable long-term outcome for dogs. Based on the recurrence of disease in four dogs with pretreatment bilateral lesions and subsequent unilateral surgery, the authors' recommendation of bilateral sacculectomy and cryptectomy for these patients seems prudent.

    Surgery of Canine Metastatic Anal Sac Adenocarcinoma

    Hobson HP, Brown MR, Rogers KS: Surgery of metastatic anal sac adenocarcinoma in five dogs. Vet Surg 2006;35:267-270.

    Because few reports have evaluated survival time and complication rate after lymphadenectomy for metastatic lesions, a retrospective study reviewed medical records of dogs that underwent surgery for metastatic apocrine gland anal sac adenocarcinoma (AGASA) between 1993 and 2003 for signalment; history; ­physical examination, clinicopathologic, and imaging data; surgical complications; number of operations; survival times; and cause of death. Five dogs that underwent lymphadenectomy, with or without additional debulking, and had AGASA that was confirmed via histologic examination were eligible for evaluation via complete blood counts, biochemical and serum electrolyte assays, radiography and/or ultrasonography, and histologic study of the regional lymph nodes and caudal abdomen.

    All dogs (three of five were mixed breed [median age: 9.9 years]; four castrated males) underwent lymphadenectomy without complications. Three dogs were euthanized—two for causes unrelated to AGASA; the median survival time was 20.6 months. One dog was clinically well 19 months after surgery; the last dog was clinically normal 54 months after initial lymphadenectomy and four additional tumor debulkings of the iliac lymph nodes, even though many tumor cells were thought to remain after each debulking.

    Key Finding:

    • Surgical removal of metastatic lesions via lymphadenectomy may allow long-term survival of dogs with metastatic AGASA.

    Downloadable PDF

    NEXT: An In-Depth Look: Left-Sided Congestive Heart Failure in Dogs: Pathophysiology and Diagnosis

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