Locoregional Lymphadenectomy in the Surgical Management of Anorectal Melanoma View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2013-01-18

AUTHORS

Daniel R. Perez, Atthaphorn Trakarnsanga, Jinru Shia, Garrett M. Nash, Larissa K. Temple, Philip B. Paty, Jose G. Guillem, Julio Garcia-Aguilar, Danielle Bello, Charlotte Ariyan, Richard D. Carvajal, Martin R. Weiser

ABSTRACT

BackgroundThe effect of lymph node metastasis on local tumor control and distant failure in patients with anorectal melanoma has not been fully studied. Understanding the significance of lymphatic dissemination might assist in stratifying patients for either organ preservation or radical surgery.MethodsA retrospective review of all patients with anorectal melanoma who underwent surgery at our institution between 1985 and 2010. Abdominoperineal resection (APR) was performed in 25 patients (39 %), and wide local excision (WLE) in 40 (61%). Extent of primary surgery and locoregional lymphadenectomy (mesorectal vs. inguinal vs. none) and pattern of treatment failure were analyzed. Recurrence-free survival (RFS) and disease-specific survival (DSS) were calculated.ResultsIn patients undergoing APR, DSS was not associated with presence (29 %) or absence (71 %) of metastatic melanoma in mesorectal lymph nodes. There was a trend toward improved DSS in patients with clinically negative inguinal lymph nodes (n = 17) compared with patients with proven inguinal metastasis (n = 6; P = 0.12). Type of surgery (WLE vs. APR) was not associated with subsequent development of distant disease. Twelve patients (18 %) had synchronous local and distant recurrence. Synchronous recurrence was not associated with surgical strategy used to treat primary tumor (P = 0.28). Perineural invasion (PNI) was significantly correlated with RFS (P = 0.002).ConclusionsOutcome following resection of anorectal melanoma is independent of locoregional lymph node metastasis; lymphadenectomy should be reserved for gross symptomatic disease. PNI is a powerful prognostic marker warranting further exploration in clinical trials. More... »

PAGES

2339-2344

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-012-2812-6

DOI

http://dx.doi.org/10.1245/s10434-012-2812-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1015755986

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/23328972


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74 negative inguinal lymph nodes
75 node metastasis
76 nodes
77 organ preservation
78 patients
79 patterns
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81 powerful prognostic marker
82 presence
83 preservation
84 primary surgery
85 primary tumor
86 prognostic marker
87 radical surgery
88 recurrence
89 recurrence-free survival
90 resection
91 retrospective review
92 review
93 significance
94 strategies
95 subsequent development
96 surgery
97 surgical management
98 surgical strategy
99 survival
100 symptomatic disease
101 synchronous recurrence
102 treatment failure
103 trends
104 trials
105 tumor control
106 tumors
107 type of surgery
108 types
109 wide local excision
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