Abdominoperineal resection provides better local control but equivalent overall survival to local excision of anorectal malignant melanoma

Akihisa Matsuda, Masao Miyashita, Satoshi Matsumoto, Goro Takahashi, Takeshi Matsutani, Takeshi Yamada, Taro Kishi, Eiji Uchida

研究成果: Article査読

27 被引用数 (Scopus)

抄録

Objective: To determine whether the extent of surgery is associated with survival in anorectal malignant melanoma (ARMM). Background: ARMM is a rare and highly malignant neoplasm with unfavorable prognosis. The optimal surgical management, abdominoperineal resection (APR) or local excision (LE), has been long debated, but conclusive evidence has not been obtained. Methods: A comprehensive electronic literature search was performed to identify studies evaluating survival between APR and LE for ARMM. The main outcome measures were overall survival, relapse-free survival, and local recurrence. A meta-analysis was performed using the random-effects models to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Results: Thirty-one studies, with a total of 1006 patients [544 (54.1%) APR and 462 (45.9%) LE], were included. Meta-analyses showed that overall survival (OR, 1.14; 95% CI, 0.74-1.76; P = 0.54) and relapse-free survival (OR, 0.95; 95% CI, 0.43-2.09; P = 0.89) did not differ significantly between the APR and LE groups. APR significantly reduced local recurrence compared with LE (OR, 0.18; 95% CI, 0.09-0.36; P < 0.00001). Conclusions: Although several limitations, such as inclusion of only retrospective studies with relatively small sample size and selection biases for surgical procedure, are involved, this meta-analysis suggested that APR has no survival benefit; however, APR confers better local control than LE. Given that local failures after LE could be managed by salvage surgery, minimizing morbidity and maximizing quality of life should be the focus in surgical treatment of ARMM.

本文言語English
ページ(範囲)670-677
ページ数8
ジャーナルAnnals of Surgery
261
4
DOI
出版ステータスPublished - 04-2015

All Science Journal Classification (ASJC) codes

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