广泛局部切除或腹会阴联合切除术作为肛管直肠黑色素瘤的初始治疗方法？
Wide local excision or abdominoperineal resection as the initial treatment for anorectal melanoma?
作者信息
Droesch John T, Flum David R, Mann Gary N
机构信息
Department of Surgery, University of Washington, 1959 N.E. Pacific St., Box 356410, Seattle, WA 98195-6410, USA.
出版信息
Am J Surg. 2005 Apr;189(4):446-9. doi: 10.1016/j.amjsurg.2005.01.022.
BACKGROUND
Anorectal melanoma (AM) is a rare tumor with a poor prognosis. Treatment with abdominoperineal resection (APR) over wide local excision (WLE) is still debated. This study aimed to compare median survival of WLE and APR in patients with AM.
METHODS
A systematic review of the literature was performed. Only series that allowed calculation of median survival were included.
RESULTS
Fourteen studies met inclusion criteria. Average median survival of stage I WLE patients (N=34) and stage I APR patients (N=31) was 44 and 22 months, respectively (P=.001). For stage II patients, 7 underwent WLE, and 10 underwent APR with an average median survival of 36 and 14 months, respectively (P=.19).
CONCLUSIONS
This study identified no stage-specific survival advantage to APR in favor of AM. Given that WLE is a more limited intervention associated with at least comparable survival, we propose that it be considered the initial treatment of choice for AM.
背景
肛管直肠癌（AM）是一种罕见的肿瘤，预后较差。腹会阴联合切除术（APR）与广泛局部切除术（WLE）相比，哪种治疗方式更优仍存在争议。本研究旨在比较AM患者接受WLE和APR后的中位生存期。
方法
对文献进行系统回顾。仅纳入那些能够计算中位生存期的系列研究。
结果
14项研究符合纳入标准。I期接受WLE的患者（N = 34）和接受APR的患者（N = 31）的平均中位生存期分别为44个月和22个月（P = 0.001）。II期患者中，7例接受WLE，10例接受APR，平均中位生存期分别为36个月和14个月（P = 0.19）。
结论
本研究未发现APR在AM治疗中有特定阶段的生存优势。鉴于WLE是一种创伤较小的干预措施，且生存期至少相当，我们建议将其作为AM的首选初始治疗方法。
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