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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2013

01-07-2013 | Gastrointestinal Oncology

Locoregional Lymphadenectomy in the Surgical Management of Anorectal Melanoma

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

Published in: Annals of Surgical Oncology | Issue 7/2013

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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.
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Metadata
Title
Locoregional Lymphadenectomy in the Surgical Management of Anorectal Melanoma
Authors
Daniel R. Perez, MD
Atthaphorn Trakarnsanga, MD
Jinru Shia, MD
Garrett M. Nash, MD
Larissa K. Temple, MD
Philip B. Paty, MD
Jose G. Guillem, MD, MPH
Julio Garcia-Aguilar, MD, PhD
Danielle Bello, MD
Charlotte Ariyan, MD
Richard D. Carvajal, MD
Martin R. Weiser, MD
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2812-6

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