Vorpahl U, Jäger E, Schmidbauer U, Henneking K
Klinik für Allgemein- und Thoraxchirurgie, Justus-Liebig-Universität Giessen.
Zentralbl Chir. 1996;121(6):483-6.
The anorectal melanoma is a tumor with an unfavorable prognosis. The surgical removal is the therapy of choice. In the literature the different surgical centers suggest either local excision of the tumor or a more radical surgical procedure, the abdominoperineal resection either with or without inguinal and parailiacal lymph node dissection. Considering all therapeutic results the abdominoperineal resection seems to be the therapy with an advantage regarding the prognosis as the results of our own patients show. A groin lymph node dissection should only be performed if the lymph nodes are enlarged. Comparing studies which demonstrate a favorable prognostic influence of elective groin lymph node dissection are not available. Regarding the poor prognosis of the anorectal melanoma we consider an adjuvant chemo- or immunotherapy to be justified. If this will influence the clinical outcome is still a subject of discussion.
肛管直肠癌是一种预后不良的肿瘤。手术切除是首选治疗方法。文献中不同的外科中心建议要么对肿瘤进行局部切除,要么采用更激进的手术方式,即腹会阴联合切除术,可选择或不选择腹股沟及髂旁淋巴结清扫。综合所有治疗结果来看,正如我们自己患者的结果所示,腹会阴联合切除术似乎是在预后方面具有优势的治疗方法。仅当淋巴结肿大时才应进行腹股沟淋巴结清扫。目前尚无显示选择性腹股沟淋巴结清扫对预后有良好影响的对比研究。鉴于肛管直肠癌预后较差,我们认为辅助化疗或免疫治疗是合理的。这是否会影响临床结果仍是一个讨论的话题。