Abdominoperineal Resection Provides Better Local Control But Equivalent Overall Survival to Local Excision of Anorectal Malignant Melanoma A Systematic Review
Abdominoperineal Resection Provides Better Local Control But Equivalent Overall Survival to Local Excision of Anorectal Malignant Melanoma A Systematic Review
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DOI：
10.1097/sla.0000000000000862
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发表时间：
2015-04-01
影响因子：
9
通讯作者：
Uchida, Eiji
中科院分区：
文献类型：
--
作者：
Matsuda, Akihisa;Miyashita, Masao;Uchida, Eiji
目的：目的：探讨肛门直肠恶性黑色素瘤（ARMM）的手术范围是否与生存率相关。背景：ARMM是一种罕见的高度恶性肿瘤，预后不良。最佳的手术治疗，腹会阴切除术（APR）或局部切除术（LE），长期以来一直存在争议，但确凿的证据还没有获得.Methods：进行了全面的电子文献检索，以确定研究评估APR和LE之间的生存ARMM。主要结果指标为总生存率、无复发生存率和局部复发率。结果：共纳入31篇研究，共1006例患者[544例（54.1%）APR和462例（45.9%）LE]。荟萃分析显示，APR组和LE组的总生存期（OR，1.14; 95%CI，0.74-1.76; P = 0.54）和无复发生存期（OR，0.95; 95%CI，0.43-2.09; P = 0.89）无显著差异。与LE相比，APR显著降低了局部复发结论：本荟萃分析虽然存在样本量小、选择手术方式存在偏倚等局限性，但仍提示APR无生存益处;然而，APR赋予比LE更好的局部控制。考虑到LE后局部失败可以通过挽救性手术进行管理，最大限度地减少发病率和最大限度地提高生活质量应该是ARMM手术治疗的重点。
Objective: To determine whether the extent of surgery is associated with survival in anorectal malignant melanoma (ARMM).Background: ARMM is a rare and highly malignant neoplasm with unfavorable prognosis. The optimal surgical management, abdominoperineal resection (APR) or local excision (LE), has been long debated, but conclusive evidence has not been obtained.Methods: A comprehensive electronic literature search was performed to identify studies evaluating survival between APR and LE for ARMM. The main outcome measures were overall survival, relapse-free survival, and local recurrence. A meta-analysis was performed using the random-effects models to calculate the odds ratios (ORs) and 95% confidence intervals (CIs).Results: Thirty-one studies, with a total of 1006 patients [544 (54.1%) APR and 462 (45.9%) LE], were included. Meta-analyses showed that overall survival (OR, 1.14; 95% CI, 0.74-1.76; P = 0.54) and relapse-free survival (OR, 0.95; 95% CI, 0.43-2.09; P = 0.89) did not differ significantly between the APR and LE groups. APR significantly reduced local recurrence compared with LE (OR, 0.18; 95% CI, 0.09-0.36; P < 0.00001).Conclusions: Although several limitations, such as inclusion of only retrospective studies with relatively small sample size and selection biases for surgical procedure, are involved, this meta-analysis suggested that APR has no survival benefit; however, APR confers better local control than LE. Given that local failures after LE could be managed by salvage surgery, minimizing morbidity and maximizing quality of life should be the focus in surgical treatment of ARMM.