Locoregional lymphadenectomy in the surgical management of anorectal melanoma Journal Article

Authors: Perez, D. R.; Trakarnsanga, A.; Shia, J.; Nash, G. M.; Temple, L. K.; Paty, P. B.; Guillem, J. G.; Garcia-Aguilar, J.; Bello, D.; Ariyan, C.; Carvajal, R. D.; Weiser, M. R.
Article Title: Locoregional lymphadenectomy in the surgical management of anorectal melanoma
Abstract: Background: The 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. Methods: A 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. Results: In 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). Conclusions: Outcome 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. © 2013 Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 20
Issue: 7
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2013-07-01
Start Page: 2339
End Page: 2344
Language: English
DOI: 10.1245/s10434-012-2812-6
PROVIDER: scopus
PUBMED: 23328972
PMCID: PMC4717469
Notes: - "Export Date: 1 July 2013" - "CODEN: ASONF" - "Source: Scopus"
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MSK Authors
  1. Philip B Paty
    367 Paty
  2. Richard D Carvajal
    133 Carvajal
  3. Jose Guillem
    364 Guillem
  4. Daniel Perez
    7 Perez
  5. Jinru Shia
    450 Shia
  6. Martin R Weiser
    338 Weiser
  7. Charlotte Eielson Ariyan
    77 Ariyan
  8. Garrett Nash
    130 Nash
  9. Larissa Temple
    178 Temple
  10. Danielle Marie Bello
    14 Bello