Dubé P, Elias D, Bonvalot S, Spatz A, Lasser P
Département de Chirurgie, Institut Gustave-Roussy, Centre de Lutte Contre le Cancer, Villejuif.
J Chir (Paris). 1997 May;134(1):3-8.
The aim of this study was to determine the significant prognostic factors for primary anorectal melanoma and propose a standard surgical procedure.
From 1975 to 1995, 19 patients with primary melanoma of the anus were treated. Five patients were given palliative care, 6 had abdominoperineal amputation and 8 had curative local transrectal tumoral excision. Two patients also underwent inguinal node dissection.
Overall 5-year survival was 21%. Univariate analysis showed a significantly poorer prognosis when: inguinal or pelvic nodes were invaded (p = 0.01), surgical margins were invaded (p = 0.003), visceral metastases were present (p = 0.01) and the tumor measured over 20 mm thick (p = 0.01). Prognosis was unchanged by the type of surgical exeresis.
Local transrectal excision is the first ling choice for primary anorectal melanoma. Amputation of the rectum should be reserved for cases where complete tumor resection is technically impossible transrectally. Node dissection is indicated in cases with clinical invasion of the inguinal nodes.
本研究旨在确定原发性肛管直肠黑色素瘤的重要预后因素，并提出一种标准手术方法。
1975年至1995年期间，对19例原发性肛门黑色素瘤患者进行了治疗。5例接受姑息治疗，6例行腹会阴联合切除术，8例行根治性经直肠肿瘤局部切除术。2例患者还接受了腹股沟淋巴结清扫术。
总体5年生存率为21%。单因素分析显示，当出现以下情况时预后明显较差：腹股沟或盆腔淋巴结受侵（p = 0.01）、手术切缘受侵（p = 0.003）、存在内脏转移（p = 0.01）以及肿瘤厚度超过20 mm（p = 0.01）。手术切除类型对预后无影响。
经直肠局部切除术是原发性肛管直肠黑色素瘤的首选治疗方法。对于经直肠无法实现肿瘤完全切除的病例，应保留直肠切除术。对于腹股沟淋巴结有临床受侵的病例，应行淋巴结清扫术。
Zotero 插件