Goldman S, Glimelius B, Påhlman L
Department of Surgery, Södersjukhuset, Stockholm, Sweden.
Dis Colon Rectum. 1990 Oct;33(10):874-7. doi: 10.1007/BF02051925.
Clinicopathologic features and prognosis of 49 patients with anal malignant melanoma were investigated in the total Swedish population between 1970 and 1984. Median age was 71 years (range, 50 to 87 years), and there was a female predominance (31 females, 18 males). The most common symptom at presentation was bleeding. The majority of tumors ranged between 2 and 5 cm in diameter and all invaded at least into the submucosa and/or the lamina propria. At diagnosis, one third of the patients had either regional or distant metastasis with a median survival of 5 months. The remaining patients were surgically treated with curative intent, either by abdominoperineal resection (APR) or local excision. Median survival was poor in both treatment groups (APR, 12 months; local excision, 13 months). Most patients died with distant metastasis. Our results confirm the opinion that APR offers no more curative potential than a more conservative surgical approach. However, tumor sizes were on average smaller in the group treated by local excision. This could indicate that, in the absence of known distant metastasis, radical surgery should be performed, particularly since local recurrences tended to be more common after a local excision.
对1970年至1984年间瑞典全体人口中49例肛管恶性黑色素瘤患者的临床病理特征及预后进行了研究。中位年龄为71岁（范围50至87岁），女性占优势（31例女性，18例男性）。就诊时最常见的症状是出血。大多数肿瘤直径在2至5厘米之间，均至少侵犯至黏膜下层和/或固有层。诊断时，三分之一的患者有区域或远处转移，中位生存期为5个月。其余患者接受了旨在治愈的手术治疗，要么行腹会阴联合切除术（APR），要么行局部切除术。两个治疗组的中位生存期均较差（APR组为12个月；局部切除组为13个月）。大多数患者死于远处转移。我们的结果证实了这样一种观点，即与更保守的手术方法相比，APR并没有更大的治愈潜力。然而，局部切除组的肿瘤平均尺寸较小。这可能表明，在没有已知远处转移的情况下，应进行根治性手术，特别是因为局部切除后局部复发往往更常见。
