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Less is more: A systematic review and meta-analysis of the outcomes of radical versus conservative primary resection in anorectal melanoma

Publikation: Bidrag til tidsskriftReviewpeer review

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  • Henry G Smith
  • Jessica Glen
  • Nancy Turnbull
  • Howard Peach
  • Ruth Board
  • Miranda Payne
  • Martin Gore
  • Karen Nugent
  • Myles J F Smith
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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.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Cancer
Vol/bind135
Sider (fra-til)113-120
Antal sider8
ISSN0959-8049
DOI
StatusUdgivet - aug. 2020

Bibliografisk note

Copyright © 2020 Elsevier Ltd. All rights reserved.

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