Droesch John T, Flum David R, Mann Gary N
Department of Surgery, University of Washington, 1959 N.E. Pacific St., Box 356410, Seattle, WA 98195-6410, USA.
Am J Surg. 2005 Apr;189(4):446-9. doi: 10.1016/j.amjsurg.2005.01.022.
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.
A systematic review of the literature was performed. Only series that allowed calculation of median survival were included.
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).
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.
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。
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。
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）。
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。
