{"title":"肛门直肠黑色素瘤手术治疗:三级癌症中心分析","authors":"R. Arjunan, C. Ramach, P. Jonnada, U. Karjol","doi":"10.4103/WJCS.WJCS_17_19","DOIUrl":null,"url":null,"abstract":"Background: Primary rectal malignant melanoma is an exceptionally rare neoplasm associated with an extremely poor prognosis despite aggressive treatment. The described management options for localized disease are abdominoperineal resection (APR) and wide local excision (WLE) with or without radiation. Objective: To assess the surgical outcomes of the patients with anorectal melanoma. Design and Setting: Retrospective study. Patients and Methods: This retrospective study describes the experience in surgical management of 18 cases of anorectal melanoma treated surgically at our center, between 2010 and 2015. Main Outcome Measures: To assess the median survival and recurrence rates of anorectal melanoma patients who underwent surgery. Sample size: Eighteen cases. Results: This is a retrospective study of 18 cases of anorectal melanoma. APR was performed in 77.8%, wide excision (WLE) in 16.7%, and posterior exenteration in 5.6%. The median survival of patients undergoing APR was 14.66 months and median survival of patients undergoing WLE was 18 months. No significant difference in median survival was observed in the patients undergoing abdominoperineal resection (APR) or wide local excision (P = 0.168). A significant difference in median survival between the node negative group and node positive group was observed (17 months vs 13.4 months P = 0.019). The median survival of patients with stage I, II, and III cancers were 17.28 months, 16 months, and 13.4 months, respectively. A statistically significant difference in median survival was found between patients with lympho-vascular invasive and noninvasive cancer (13.37 months vs 16.7 months P = 0.029). There was no significant difference in the recurrence rate between APR and WLE groups (86% vs 66% P = 0.893).Conclusion: Anorectal melanoma is an aggressive disease which require timely diagnosis. Nodal status is an important factor that impact median survival. There is no significant difference in survival when WLE compared to APR. Node positivity and lympho-vascular invasion confer poor prognosis. Recurrence rates are identical regardless of the surgical approach. Limitations: It is a retrospective series based on case records. A major drawback of this investigation is the limited detail available for each case. Not all patients who underwent local excision received radiotherapy. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Anorectal melanoma surgical management: A tertiary cancer centre analysis\",\"authors\":\"R. Arjunan, C. Ramach, P. Jonnada, U. Karjol\",\"doi\":\"10.4103/WJCS.WJCS_17_19\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Primary rectal malignant melanoma is an exceptionally rare neoplasm associated with an extremely poor prognosis despite aggressive treatment. The described management options for localized disease are abdominoperineal resection (APR) and wide local excision (WLE) with or without radiation. Objective: To assess the surgical outcomes of the patients with anorectal melanoma. Design and Setting: Retrospective study. Patients and Methods: This retrospective study describes the experience in surgical management of 18 cases of anorectal melanoma treated surgically at our center, between 2010 and 2015. Main Outcome Measures: To assess the median survival and recurrence rates of anorectal melanoma patients who underwent surgery. Sample size: Eighteen cases. Results: This is a retrospective study of 18 cases of anorectal melanoma. APR was performed in 77.8%, wide excision (WLE) in 16.7%, and posterior exenteration in 5.6%. The median survival of patients undergoing APR was 14.66 months and median survival of patients undergoing WLE was 18 months. No significant difference in median survival was observed in the patients undergoing abdominoperineal resection (APR) or wide local excision (P = 0.168). A significant difference in median survival between the node negative group and node positive group was observed (17 months vs 13.4 months P = 0.019). The median survival of patients with stage I, II, and III cancers were 17.28 months, 16 months, and 13.4 months, respectively. A statistically significant difference in median survival was found between patients with lympho-vascular invasive and noninvasive cancer (13.37 months vs 16.7 months P = 0.029). There was no significant difference in the recurrence rate between APR and WLE groups (86% vs 66% P = 0.893).Conclusion: Anorectal melanoma is an aggressive disease which require timely diagnosis. Nodal status is an important factor that impact median survival. There is no significant difference in survival when WLE compared to APR. Node positivity and lympho-vascular invasion confer poor prognosis. Recurrence rates are identical regardless of the surgical approach. Limitations: It is a retrospective series based on case records. A major drawback of this investigation is the limited detail available for each case. Not all patients who underwent local excision received radiotherapy. Conflict of Interest: None.\",\"PeriodicalId\":90396,\"journal\":{\"name\":\"World journal of colorectal surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2019-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World journal of colorectal surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/WJCS.WJCS_17_19\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World journal of colorectal surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/WJCS.WJCS_17_19","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:原发性直肠恶性黑色素瘤是一种非常罕见的肿瘤,尽管积极治疗,但预后极差。所描述的局部疾病的治疗选择是腹部会阴切除(APR)和广泛局部切除(WLE),有或没有放疗。目的:探讨肛肠黑色素瘤的手术治疗效果。设计与设定:回顾性研究。患者和方法:本回顾性研究描述了2010年至2015年在我中心手术治疗的18例肛管直肠黑色素瘤的手术治疗经验。主要结局指标:评估肛管直肠黑色素瘤手术患者的中位生存率和复发率。样本量:18例。结果:对18例肛管直肠黑色素瘤进行回顾性研究。APR占77.8%,宽切除(WLE)占16.7%,后路切除占5.6%。APR患者的中位生存期为14.66个月,WLE患者的中位生存期为18个月。腹会阴切除术(APR)和广泛局部切除术患者的中位生存期无显著差异(P = 0.168)。淋巴结阴性组和淋巴结阳性组的中位生存期有显著差异(17个月vs 13.4个月P = 0.019)。I期、II期和III期癌症患者的中位生存期分别为17.28个月、16个月和13.4个月。淋巴血管浸润性癌与非浸润性癌患者的中位生存期差异有统计学意义(13.37个月vs 16.7个月P = 0.029)。APR组与WLE组复发率差异无统计学意义(86% vs 66% P = 0.893)。结论:肛肠黑色素瘤是一种侵袭性疾病,需要及时诊断。淋巴结状态是影响中位生存期的重要因素。与apr相比,WLE的生存率无显著差异。淋巴结阳性和淋巴血管浸润导致预后不良。无论采用何种手术方式,复发率都是相同的。局限性:这是一个基于病例记录的回顾性系列研究。这种调查的一个主要缺点是每个案件的细节有限。并非所有接受局部切除的患者都接受了放疗。利益冲突:无。
Anorectal melanoma surgical management: A tertiary cancer centre analysis
Background: Primary rectal malignant melanoma is an exceptionally rare neoplasm associated with an extremely poor prognosis despite aggressive treatment. The described management options for localized disease are abdominoperineal resection (APR) and wide local excision (WLE) with or without radiation. Objective: To assess the surgical outcomes of the patients with anorectal melanoma. Design and Setting: Retrospective study. Patients and Methods: This retrospective study describes the experience in surgical management of 18 cases of anorectal melanoma treated surgically at our center, between 2010 and 2015. Main Outcome Measures: To assess the median survival and recurrence rates of anorectal melanoma patients who underwent surgery. Sample size: Eighteen cases. Results: This is a retrospective study of 18 cases of anorectal melanoma. APR was performed in 77.8%, wide excision (WLE) in 16.7%, and posterior exenteration in 5.6%. The median survival of patients undergoing APR was 14.66 months and median survival of patients undergoing WLE was 18 months. No significant difference in median survival was observed in the patients undergoing abdominoperineal resection (APR) or wide local excision (P = 0.168). A significant difference in median survival between the node negative group and node positive group was observed (17 months vs 13.4 months P = 0.019). The median survival of patients with stage I, II, and III cancers were 17.28 months, 16 months, and 13.4 months, respectively. A statistically significant difference in median survival was found between patients with lympho-vascular invasive and noninvasive cancer (13.37 months vs 16.7 months P = 0.029). There was no significant difference in the recurrence rate between APR and WLE groups (86% vs 66% P = 0.893).Conclusion: Anorectal melanoma is an aggressive disease which require timely diagnosis. Nodal status is an important factor that impact median survival. There is no significant difference in survival when WLE compared to APR. Node positivity and lympho-vascular invasion confer poor prognosis. Recurrence rates are identical regardless of the surgical approach. Limitations: It is a retrospective series based on case records. A major drawback of this investigation is the limited detail available for each case. Not all patients who underwent local excision received radiotherapy. Conflict of Interest: None.