Local excision offers better survival than abdominoperineal resection for anal squamous cell carcinoma post-chemoradiotherapy.

• 5-year overall survival: 75% for local excision vs. 46.1% for abdominoperineal resection (p < .001).
• Local excision had lower 90-day mortality (0.9% vs. 5.1%, p < .001) and lower 30-day readmission rates (1.5% vs. 7.7%, p < .001).

Despite more positive surgical margins (66.6% vs. 25.1%, p < .001), local excision significantly improves patient outcomes.