Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands.
Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
BJS Open. 2021 Nov 9;5(6). doi: 10.1093/bjsopen/zrab107.
Anorectal melanoma is a rare neoplasm with a poor prognosis. The surgical approaches for anorectal melanoma can be categorized into local excision (procedures without lymph node removal and preservation of the rectum) and extensive resection (procedures with rectum and pararectal lymph node removal). The aim of this systematic review and meta-analysis was to compare the survival of patients who underwent extensive resection with that of patients who underwent local excision, stratifying patients according to tumour stage.
A literature review was performed according to PRISMA guidelines by searching MEDLINE/PubMed for manuscripts published until March 2021. Studies comparing survival outcomes in patients with anorectal melanoma who underwent local excision versus extensive resection were screened for eligibility. Meta-analysis was performed for overall survival after the different surgical approaches, stratified by tumour stage.
There were 347 studiesidentified of which 34 were included for meta-analysis with a total of 1858 patients. There was no significant difference in overall survival between the surgical approaches in patients per stage (stage I odds ratio 1.30 (95 per cent c.i. 0.62 to 2.72, P = 0.49); stage II odds ratio 1.61 (95 per cent c.i. 0.62 to 4.18, P = 0.33); stage I-III odds ratio 1.19 (95 per cent c.i. 0.83 to 1.70, P = 0.35). Subgroup analyses were conducted for the time intervals (<2000, 2001-2010 and 2011-2021) and for continent of study origin. Subgroup analysis for time interval and continent of origin also showed no statistically significant differences in overall survival.
No significant survival benefit exists for patients with anorectal melanoma treated with local excision or extensive resection, independent of tumour stage.
肛门直肠黑色素瘤是一种预后较差的罕见肿瘤。肛门直肠黑色素瘤的手术方法可分为局部切除（不进行淋巴结切除和保留直肠的手术）和广泛切除（包括直肠和直肠旁淋巴结切除的手术）。本系统评价和荟萃分析的目的是比较行广泛切除术和局部切除术的患者的生存情况，并按肿瘤分期对患者进行分层。
根据 PRISMA 指南，通过搜索 MEDLINE/PubMed 进行文献回顾，检索截至 2021 年 3 月发表的文献。筛选出比较肛门直肠黑色素瘤患者行局部切除与广泛切除的生存结果的研究，以确定其是否符合纳入标准。对不同手术方法的总生存率进行荟萃分析，并按肿瘤分期进行分层。
共确定了 347 项研究，其中 34 项研究纳入荟萃分析，共纳入 1858 例患者。按分期，不同手术方法之间的总生存率无显著差异（Ⅰ期：优势比 1.30（95%可信区间 0.62 至 2.72，P = 0.49）；Ⅱ期：优势比 1.61（95%可信区间 0.62 至 4.18，P = 0.33）；Ⅰ-Ⅲ期：优势比 1.19（95%可信区间 0.83 至 1.70，P = 0.35）。进行了时间间隔（<2000 年、2001-2010 年和 2011-2021 年）和研究起源大洲的亚组分析。时间间隔和研究起源大洲的亚组分析也显示，总生存率无统计学差异。
对于肛门直肠黑色素瘤患者，局部切除或广泛切除治疗均无明显生存获益，与肿瘤分期无关。
