The Nigro protocol using definitive chemoradiotherapy is the primary treatment for most cases of anal squamous cell carcinoma (SCC), which encompasses >90% of anal cancers. Surgery is indicated for the treatment of (i) perianal cancers without sphincter involvement, (ii) patients with persistent or recurrent disease following initial chemoradiation therapy, (iii) complications of primary disease, and (iv) complications resulting from nonoperative therapy. Major pelvic surgery is reserved for locally persistent or recurrent disease, occurring in 10–30% of cases. Patients who are HIV positive, those with advanced T or N stage, or incomplete chemoradiation therapy have an increased risk of persistence and recurrence and require salvage surgery. Conventional abdominal perineal resection (APR) or extra-levator abdominal perineal resection (ELAPE) if there is disease extending beyond the anal sphincter, are the most common salvage operations performed for anal SCC. This chapter will focus primarily on the management of complications of APR/ELAPE surgery for progressive disease including (i) perineal wound complications; (ii) pelvic fluid collections/abscess/organ space infection; (iii) perineal hernia; and (iv) small bowel obstruction as well as those secondary to primary disease and primary chemoradiation therapy. Complications of primary disease and nonoperative therapy are also discussed, including large bowel obstruction, fecal incontinence, rectovaginal and anorectal fistulae, sigmoid and ureteral stricture formation, and radiation enteritis.