Surgical Management of Primary Anorectal Melanoma: Is Less More?

IF 1.6 Q4 ONCOLOGY

Journal of Gastrointestinal Cancer Pub Date : 2024-06-01 Epub Date: 2024-01-05 DOI:10.1007/s12029-023-01009-z

Michael G Fadel, Hesham S Mohamed, Justin Weir, Andrew J Hayes, James Larkin, Myles J Smith

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引用次数: 0

Abstract

Purpose: Ano-uro-genital (AUG) Mucosal Melanoma UK guidelines recommended a less radical surgical strategy for anorectal melanoma (ARM) where possible. We report our experience of ARM consistent with that approach including clinical presentation, intervention undertaken and prognosis.

Methods: We present a retrospective study of 15 consecutive patients with ARM surgically treated between November 2014 and April 2023. Patients were divided into the two surgery types: wide local excision (WLE, n = 9) and abdominoperineal resection (APR, n = 6). Data on demographics, diagnosis, treatment and oncological outcomes were assessed between the groups.

Results: The mean age was 65.3 ± 17.4 years and 6 (40.0%) were female patients. Nine patients (60.0%) were diagnosed with stage I and six patients (40.0%) with stage II disease. R0 margins were achieved in all cases. The overall mean length of stay was lower following WLE compared to APR (2.6 ± 2.4 days versus 14.0 ± 9.8 days, p = 0.032). Two complications were observed in the WLE group compared to four complications after APR (p = 0.605). Five patients (55.5%) developed local/distant recurrence in the WLE group compared to three patients (50.0%) in the APR group (p = 0.707), with a median overall survival of 38.5 (12-83) months versus 26.5 (14-48) months, respectively.

Conclusions: Achieving clear margins by the least radical fashion may have equivalent oncological outcomes to radical surgery, potentially reducing patient morbidity and preserving function. In our experience, the surgical management of ARM consistent with the 'less is more' approach adhering to AUG guidelines has acceptable outcomes.

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原发性肛门直肠黑色素瘤的手术治疗：越少越好吗？

目的：肛门-直肠-生殖器（AUG）粘膜黑色素瘤英国指南建议尽可能对肛门直肠黑色素瘤（ARM）采取不那么激进的手术策略。我们报告了与该方法一致的 ARM 经验，包括临床表现、采取的干预措施和预后：我们对 2014 年 11 月至 2023 年 4 月间接受手术治疗的 15 例连续 ARM 患者进行了回顾性研究。患者被分为两种手术类型：局部广泛切除术（WLE，n = 9）和腹会阴切除术（APR，n = 6）。对两组患者的人口统计学、诊断、治疗和肿瘤学结果等数据进行评估：平均年龄（65.3±17.4）岁，女性患者 6 例（40.0%）。九名患者（60.0%）被诊断为 I 期，六名患者（40.0%）被诊断为 II 期。所有病例的边缘均达到 R0。与 APR 相比，WLE 的总平均住院时间更短（2.6 ± 2.4 天对 14.0 ± 9.8 天，P = 0.032）。WLE组出现了两种并发症，而APR组出现了四种并发症（p = 0.605）。WLE组有5名患者（55.5%）出现局部/远处复发，而APR组有3名患者（50.0%）（p = 0.707），中位总生存期分别为38.5（12-83）个月和26.5（14-48）个月：结论：以最不激进的方式获得清晰的边缘可能与激进手术具有同等的肿瘤治疗效果，并有可能降低患者的发病率和保护患者的功能。根据我们的经验，按照AUG指南，以 "少即是多 "的方式对ARM进行手术治疗，结果是可以接受的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.