Geisler J P, Look K Y, Moore D A, Sutton G P
Division of Gynecologic Oncology-Department of Obstetrics and Gynecology, Indiana University Medical Center, Indianapolis 46202, USA.
Gynecol Oncol. 1995 Dec;59(3):338-41. doi: 10.1006/gyno.1995.9966.
Pelvic exenteration has usually been employed as salvage treatment for gynecologic malignancies which have failed primary radiotherapy. The therapeutic mainstay for vulvar melanomas has become wide local excision with or without concurrent regional node dissection. Patients with primary melanoma of the vagina who undergo exenteration as primary therapy may experience 50% 5-year survival if the pelvic nodes are free of metastases. However, the overall 5-year survival for vaginal melanoma is 15%. In our patient population, there have been four patients with vaginal or urethral melanomas treated primarily with pelvic exenteration. The purpose of this study was to report that patients with vaginal or urethral melanomas over 3 mm in thickness may benefit from primary pelvic exenteration. Four patients underwent pelvic exenteration at Indiana University Medical Center for malignant melanoma of the vagina or urethra between 1986 and 1992. The pathologic specimens of all patients were analyzed for thickness, growth pattern, and nodal metastases. Patient age ranged from 50 to 71. Thickness of the melanomas ranged from > 3 to 12 mm. All four patients underwent exenterations, three total and one anterior. All patients had negative pelvic and inguinal nodes at the time of surgery. None of the patients has experienced a recurrence. Three of four patients are alive without evidence of disease at 31 to 97 months following their exenteration. One patient died postoperatively of cardiopulmonary complications. Patients with melanomas of the vagina and female urethra, greater than 3 mm in thickness, may benefit from primary pelvic exenteration.
盆腔脏器清除术通常被用作对原发性放射治疗失败的妇科恶性肿瘤的挽救性治疗。外阴黑色素瘤的主要治疗方法已变为广泛局部切除，可同时或不同时进行区域淋巴结清扫。作为初始治疗接受盆腔脏器清除术的原发性阴道黑色素瘤患者，如果盆腔淋巴结无转移，5年生存率可能为50%。然而，阴道黑色素瘤的总体5年生存率为15%。在我们的患者群体中，有4例阴道或尿道黑色素瘤患者主要接受了盆腔脏器清除术治疗。本研究的目的是报告厚度超过3mm的阴道或尿道黑色素瘤患者可能从原发性盆腔脏器清除术中获益。1986年至1992年间，4例患者在印第安纳大学医学中心因阴道或尿道恶性黑色素瘤接受了盆腔脏器清除术。对所有患者的病理标本进行了厚度、生长模式和淋巴结转移情况分析。患者年龄在50至71岁之间。黑色素瘤厚度在>3至12mm之间。4例患者均接受了脏器清除术，3例为全盆腔脏器清除术，1例为前盆腔脏器清除术。所有患者在手术时盆腔和腹股沟淋巴结均为阴性。所有患者均未出现复发。4例患者中有3例在接受脏器清除术后31至97个月存活，无疾病证据。1例患者术后死于心肺并发症。厚度大于3mm的阴道和女性尿道黑色素瘤患者可能从原发性盆腔脏器清除术中获益。
