Henry G Smith1, Jessica Glen2, Nancy Turnbull3, Howard Peach4, Ruth Board5, Miranda Payne6, Martin Gore7, Karen Nugent8, Myles J F Smith9. 1. The Skin Unit, The Royal Marsden Hospital NHS Foundation Trust, London, England, UK; Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. 2. National Guideline Centre, Royal College of Physicians, London, England, UK; The Health Research Council of New Zealand, Auckland, New Zealand. 3. Melanoma Focus, London, England, UK. 4. Leeds Teaching Hospitals NHS Foundation Trust, UK. 5. Lancashire Teaching Hospitals NHS Foundation Trust, UK. 6. Oxford University Hospitals NHS Foundation Trust, UK. 7. The Skin Unit, The Royal Marsden Hospital NHS Foundation Trust, London, England, UK. 8. University Hospital Southampton NHS Foundation Trust, UK. 9. The Skin Unit, The Royal Marsden Hospital NHS Foundation Trust, London, England, UK. Electronic address: myles.smith@rmh.nhs.uk.
Abstract
INTRODUCTION: Anorectal melanoma (ARM) is a rare disease with a poor prognosis. There is no consensus as to the optimal primary surgical treatment for ARM, with advocates for both radical (abdominoperineal resection [APR]) and conservative strategies (wide local excision [WLE]). Here, we report a systematic review of studies comparing outcomes between these strategies. METHODS: Studies comparing APR with WLE in patients with ARM were included, and a systematic review using the Grading of Recommendations, Assessment, Development and Evaluation methodology was performed. Outcomes deemed critical included overall survival, disease-free survival, local recurrence and quality of life. RESULTS: Forty studies were identified, of which 27 were suitable for inclusion. Twenty-three studies compared overall survival between WLE and APR, with no difference in outcomes noted (risk ratio [RR]: 0.80, 95% confidence interval [CI]: 0.60-1.07, p = 0.13). Seven studies compared disease-free survival, with no difference in outcomes noted (RR: 1.08, 95% CI: 0.61-1.91, p = 0.79). A total of 19 studies compared local recurrence rates, with again no significant difference in outcomes noted (RR: 0.71, 95% CI: 0.44-1.14, p = 0.16). None of the studies identified reported quality of life-related outcomes. CONCLUSION: There is no evidence to suggest that a radical primary surgical strategy improves outcomes in ARM. Therefore, given the well-documented morbidity associated with APR, WLE with regular surveillance for local recurrence should be the primary strategy in most patients.
INTRODUCTION:Anorectal melanoma (ARM) is a rare disease with a poor prognosis. There is no consensus as to the optimal primary surgical treatment for ARM, with advocates for both radical (abdominoperineal resection [APR]) and conservative strategies (wide local excision [WLE]). Here, we report a systematic review of studies comparing outcomes between these strategies. METHODS: Studies comparing APR with WLE in patients with ARM were included, and a systematic review using the Grading of Recommendations, Assessment, Development and Evaluation methodology was performed. Outcomes deemed critical included overall survival, disease-free survival, local recurrence and quality of life. RESULTS: Forty studies were identified, of which 27 were suitable for inclusion. Twenty-three studies compared overall survival between WLE and APR, with no difference in outcomes noted (risk ratio [RR]: 0.80, 95% confidence interval [CI]: 0.60-1.07, p = 0.13). Seven studies compared disease-free survival, with no difference in outcomes noted (RR: 1.08, 95% CI: 0.61-1.91, p = 0.79). A total of 19 studies compared local recurrence rates, with again no significant difference in outcomes noted (RR: 0.71, 95% CI: 0.44-1.14, p = 0.16). None of the studies identified reported quality of life-related outcomes. CONCLUSION: There is no evidence to suggest that a radical primary surgical strategy improves outcomes in ARM. Therefore, given the well-documented morbidity associated with APR, WLE with regular surveillance for local recurrence should be the primary strategy in most patients.
Authors: Josh Bleicher; Jessica N Cohan; Lyen C Huang; William Peche; T Bartley Pickron; Courtney L Scaife; Tawnya L Bowles; John R Hyngstrom; Elliot A Asare Journal: World J Gastroenterol Date: 2021-01-21 Impact factor: 5.742
Authors: Esther Jutten; Schelto Kruijff; Anne Brecht Francken; Martijn F Lutke Holzik; Barbara L van Leeuwen; Henderik L van Westreenen; Kevin P Wevers Journal: BJS Open Date: 2021-11-09