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PURPOSE: Sphincter-sparing chemoradiotherapy (CRT) is the standard of care for patients with anal canal cancer. Despite good response rates, some patients require radical surgery (abdominoperineal resection or exenteration)for persistent or recurrent disease. The purpose of this study was to evaluate the outcomes of patients following radical resection for persistent or recurrent disease. METHODS: All patients treated with CRT or RT for anal cancer between 1990 and 2008 were identified using the regional cancer registry. Inclusion criteria: pathologically confirmed squamous cell carcinoma of the anal canal, localized disease, receiving ≥ 45Gy of RT. Statistical analysis was conducted to calculate survival rates and identify risk factors for poor outcomes. RESULTS: 105 patients (25 male) were identified. Median age was 57 years (range 33-87 yr). Median follow up was 40 months (range 3185). Median T stage and size at presentation were 2 and 35 mm (range 6-260mm) respectively. Median dose to the primary tumor was 54 Gy (45-76 Gy) at a median 28 fractions (range 20-37). 92 patients(88.5%) received concurrent chemotherapy. At 3 month followup 85 (83.3%) patients had complete clinical response, one patient had insufficient followup. 19 (18.1%) patients had persistent disease, of whom 12 underwent radical resection for cure; 5 (41.7%) are alive at a median of 106 months from diagnosis, while the remaining 7 died at a median 15 months from diagnosis. Recurrence occurred in 17 (20.0 %) patients at a median time of 9 months (4-53m). 8 patients underwent radical resection for recurrence; 2 (25.0%) patients are alive at 127 and 21 months, the remaining 6 died at a median time from recurrence of 24.5 months. Overall, disease specific and disease free survival, were 66%, 71% and 67% respectively for all anal canal carcinoma patients at 5 years. Multivariate analysis showed tumor size to be a significant risk factor for disease free (aOR 1.02, 95% CI: 1.01-1.04) and overall survival (aOR 1.03, 95% CI: 1.01-1.04) for all patients. CONCLUSION: Despite good response rates to sphincter-sparing therapy, 20% still required radical resection for persistent or recurrent disease. Survival rates following radical resection are poor.