Mantas Dimitrios, Tsaparas Petros, Charalampoudis Petros, Gogas Helen, Kouraklis Gregory
2nd Propaedeutic Department of Surgery, Laiko General Hospital, Athens University School of Medicine, 17 Agiou Thoma Street, 11527 Athens, Greece.
1st Internal Medicine Department, Laiko General Hospital, Athens University School of Medicine, 17 Agiou Thoma Street, 11527 Athens, Greece.
Int J Surg Oncol. 2014;2014:987170. doi: 10.1155/2014/987170. Epub 2014 Oct 28.
Visceral metastases from malignant melanoma (stage M1c) confer a very poor prognosis, as documented on the most recent revised version of the TNM/AJCC staging system. Emergency surgery for intra-abdominal complications from the disease is rare. We report on our 5-year single institution experience with surgical management of metastatic melanoma to the viscera in the emergent setting. From 2009 to 2013, 14 patients with metastatic melanoma were admitted emergently due to an acute abdomen. Clinical manifestations encompassed intestinal obstruction and bleeding. Surgical procedures involved multiple enterectomies with primary anastomoses in 8 patients, and one patient underwent splenectomy, one adrenalectomy, one right colectomy, one gastric wedge resection, one gastrojejunal anastomosis, and one transanal debulking, respectively. The 30-day mortality was 7 percent. Median follow-up was 14 months. Median overall survival was 14 months. Median disease free survival was 7.5 months. One-year overall survival was 64.2 percent and 2-year overall survival was 14.2 percent. Emergency surgery for metastatic melanoma to the viscera is rare. Elective curative surgery combined with novel cytotoxic systemic therapies is under investigation in an attempt to grant survival benefit in melanoma patients with visceral disease.
根据最新修订版的TNM/AJCC分期系统记录，恶性黑色素瘤的内脏转移（M1c期）预后极差。因该疾病导致腹腔内并发症而进行的急诊手术很少见。我们报告了在急诊情况下对内脏转移性黑色素瘤进行手术治疗的单机构5年经验。2009年至2013年，14例转移性黑色素瘤患者因急腹症紧急入院。临床表现包括肠梗阻和出血。手术操作包括8例患者进行了多次肠切除并一期吻合，1例患者分别接受了脾切除术、肾上腺切除术、右半结肠切除术、胃楔形切除术、胃空肠吻合术和经肛门减瘤手术。30天死亡率为7%。中位随访时间为14个月。中位总生存期为14个月。无病生存期的中位数为7.5个月。1年总生存率为64.2%，2年总生存率为14.2%。内脏转移性黑色素瘤的急诊手术很少见。正在研究选择性根治性手术联合新型细胞毒性全身治疗，试图为患有内脏疾病的黑色素瘤患者带来生存益处。
