Berger A C, Buell J F, Venzon D, Baker A R, Libutti S K
Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
Ann Surg Oncol. 1999 Mar;6(2):155-60. doi: 10.1007/s10434-999-0155-8.
Melanoma metastatic to the gastrointestinal (GI) tract is asymptomatic or presents with pain, bleeding, or obstruction. To determine whether surgery influences outcomes, we reviewed our experience with this patient population.
Medical records of patients with metastatic melanoma to the GI tract were reviewed. Patients were divided into four groups, i.e., complete resection, partial debulking, unresectable, or unexplored. Analysis was performed using the Kaplan-Meier method.
Fifty patients with melanoma metastatic to the GI tract were identified (40 men and 10 women; mean age, 44 years). Presenting symptoms included pain (62%), bleeding (28%), and obstruction (18%). Diagnosis was confirmed using contrast studies (38%), endoscopy (20%), or computed tomography (30%). Thirty-six patients (61%) underwent a total of 39 operations. Seventeen patients underwent complete resection, whereas 14 underwent partial debulking. Five patients had unresectable lesions, and 14 patients did not undergo exploration because of medical contraindications. The operative mortality rate was 2.5% (1 of 39). The mean survival times for the unexplored and unresected groups were similar (4.1 months). Patients who underwent partial resection exhibited a longer mean survival time (8.9 months) than did patients in the unresected group (P < .001). The complete-resection group demonstrated a mean survival time of 23.5 months, which was significantly longer than that for patients who underwent less than complete resection (P < .0001).
Metastatic melanoma to the GI tract can result in significant morbidity and death. Surgical resection can be performed safely. Patients for whom all sites of disease are completely resected experience significant improvements in survival times, compared with patients who undergo less than complete resection. For selected patients, surgical treatment of metastatic melanoma involving the GI tract is appropriate therapy.
转移至胃肠道（GI）的黑色素瘤通常无症状，或表现为疼痛、出血或梗阻。为了确定手术是否会影响治疗结果，我们回顾了我们在这类患者群体中的经验。
回顾了胃肠道转移黑色素瘤患者的病历。患者被分为四组，即完全切除、部分减瘤、无法切除或未探查。采用Kaplan-Meier方法进行分析。
共确定了50例胃肠道转移黑色素瘤患者（40例男性和10例女性；平均年龄44岁）。主要症状包括疼痛（62%）、出血（28%）和梗阻（18%）。通过造影检查（38%）、内镜检查（20%）或计算机断层扫描（30%）确诊。36例患者（61%）共接受了39次手术。17例患者接受了完全切除，14例患者接受了部分减瘤。5例患者有无法切除的病变，14例患者因医学禁忌未进行探查。手术死亡率为2.5%（39例中的1例）。未探查组和未切除组的平均生存时间相似（4.1个月）。接受部分切除的患者的平均生存时间（8.9个月）比未切除组患者长（P <.001）。完全切除组的平均生存时间为23.5个月明显长于接受不完全切除的患者（P <.0001）。
胃肠道转移黑色素瘤可导致严重的发病率和死亡。手术切除可以安全进行。与接受不完全切除的患者相比，所有疾病部位均被完全切除的患者的生存时间有显著改善。对于选定的患者，手术治疗胃肠道转移黑色素瘤是合适的治疗方法。
