Hodgson Russell, Fink Michael A, Jones Robert M
Department of Surgery, University of Melburn, Austin Health, Melbourne, Victoria, Australia.
ANZ J Surg. 2007 Oct;77(10):855-9. doi: 10.1111/j.1445-2197.2007.04258.x.
We reviewed our experience to determine the role of resectional surgery in metastatic melanoma to the abdomen.
An observational study of 25 patients at the Austin Hospital, Melbourne from 1997 to 2005.
The median survival after abdominal resectional surgery was 8.3 (range 0.4-41.1) months. Fourteen patients who underwent resection with curative intent (extra-abdominal disease controlled and complete macroscopic clearance of abdominal disease) had improved survival compared with 11 patients who underwent palliative resection (12 month survival, 89 vs 10%, respectively, P < 0.0001). Survival was also superior in patients with up to two metastases compared with more than two (P = 0.0001) and in patients with serum albumin of at least 35 g/L (P = 0.0031). Intent of surgery (curative vs palliative) was the only factor significant on multivariate analysis (P = 0.001). Of patients with preoperative symptoms, 87% had resolution of these symptoms. Operative morbidity was 12%, and 30-day mortality was 4%.
In a highly selected group of patients with intra-abdominal melanoma metastases, resection of intra-abdominal metastases with curative intent resulted in prolonged survival compared with patients who underwent palliative resection. Those who underwent palliative resection had good relief of symptoms with minimal morbidity.
我们回顾了自身经验，以确定根治性手术在腹部转移性黑色素瘤中的作用。
对1997年至2005年在墨尔本奥斯汀医院的25例患者进行观察性研究。
腹部根治性手术后的中位生存期为8.3个月（范围0.4 - 41.1个月）。14例接受根治性切除（腹外疾病得到控制且腹部疾病实现肉眼下完全清除）的患者生存率有所提高，相比之下，11例接受姑息性切除的患者（12个月生存率分别为89%和10%，P < 0.0001）。转移灶不超过两个的患者生存率也高于超过两个转移灶的患者（P = 0.0001），血清白蛋白至少为35 g/L的患者生存率也更高（P = 0.0031）。手术意图（根治性与姑息性）是多因素分析中唯一具有显著意义的因素（P = 0.001）。有术前症状的患者中，87%的患者症状得到缓解。手术并发症发生率为12%，30天死亡率为4%。
在经过严格筛选的一组腹内黑色素瘤转移患者中，与接受姑息性切除的患者相比，以根治为目的切除腹内转移灶可延长生存期。接受姑息性切除的患者症状得到良好缓解，且并发症发生率最低。
