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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

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Smith, Henry G ; Glen, Jessica ; Turnbull, Nancy ; Peach, Howard ; Board, Ruth ; Payne, Miranda ; Gore, Martin ; Nugent, Karen ; Smith, Myles J F. / Less is more : A systematic review and meta-analysis of the outcomes of radical versus conservative primary resection in anorectal melanoma. I: European Journal of Cancer. 2020 ; Bind 135. s. 113-120.

Bibtex

@article{011ae76e028b4b27aeb27772ba0c0ab0,
title = "Less is more: A systematic review and meta-analysis of the outcomes of radical versus conservative primary resection in anorectal melanoma",
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.",
keywords = "Anus Neoplasms/mortality, Digestive System Surgical Procedures/adverse effects, Disease Progression, Disease-Free Survival, Humans, Melanoma/mortality, Neoplasm Recurrence, Local, Quality of Life, Risk Assessment, Risk Factors, Time Factors",
author = "Smith, {Henry G} and Jessica Glen and Nancy Turnbull and Howard Peach and Ruth Board and Miranda Payne and Martin Gore and Karen Nugent and Smith, {Myles J F}",
note = "Copyright {\textcopyright} 2020 Elsevier Ltd. All rights reserved.",
year = "2020",
month = aug,
doi = "10.1016/j.ejca.2020.04.041",
language = "English",
volume = "135",
pages = "113--120",
journal = "European Journal of Cancer, Supplement",
issn = "0959-8049",
publisher = "Pergamon",

}

RIS

TY - JOUR

T1 - Less is more

T2 - A systematic review and meta-analysis of the outcomes of radical versus conservative primary resection in anorectal melanoma

AU - Smith, Henry G

AU - Glen, Jessica

AU - Turnbull, Nancy

AU - Peach, Howard

AU - Board, Ruth

AU - Payne, Miranda

AU - Gore, Martin

AU - Nugent, Karen

AU - Smith, Myles J F

N1 - Copyright © 2020 Elsevier Ltd. All rights reserved.

PY - 2020/8

Y1 - 2020/8

N2 - 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.

AB - 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.

KW - Anus Neoplasms/mortality

KW - Digestive System Surgical Procedures/adverse effects

KW - Disease Progression

KW - Disease-Free Survival

KW - Humans

KW - Melanoma/mortality

KW - Neoplasm Recurrence, Local

KW - Quality of Life

KW - Risk Assessment

KW - Risk Factors

KW - Time Factors

U2 - 10.1016/j.ejca.2020.04.041

DO - 10.1016/j.ejca.2020.04.041

M3 - Review

C2 - 32563895

VL - 135

SP - 113

EP - 120

JO - European Journal of Cancer, Supplement

JF - European Journal of Cancer, Supplement

SN - 0959-8049

ER -

ID: 62416842