Published online Jan 21, 2021. doi: 10.3748/wjg.v27.i3.267
Peer-review started: December 1, 2020
First decision: December 21, 2020
Revised: December 28, 2020
Accepted: January 7, 2021
Article in press: January 7, 2021
Published online: January 21, 2021
Anorectal melanoma (ARM) is a rare disease with poor outcomes. 5-year survival remains < 20%.
Optimal surgical management of ARM remains unknown. Abdominoperineal resection (APR) and wide excision (WE) are both used and no gold standard for primary tumor management currently exists. Understanding trends in management and outcomes is critical to determining appropriate surgical management.
We aimed to update our understanding of treatment outcomes for patients with ARM and analyze trends across countries and time.
We performed a retrospective study of patients who were diagnosed with ARM at 7 hospitals in the Salt Lake City, UT region. We analyzed factors prognostic for recurrence and survival. We also performed a review of the literature to assess regional and temporal trends in ARM management.
We identified 24 patients diagnosed with ARM between 2000-01 and 2019-05. 12 (50.0%) had local, 8 (33.3%) regional, and 4 (16.7%) distant disease at diagnosis. Only 2 patients who had surgical resection of their primary tumor with curative intent failed to recur. Median time to recurrence was 10.4 mo [interquartile range (IQR) 7.5–17.2] and median overall survival was 18.8 mo (IQR 13.5–33.9). No patients survived to 5 years. No survival differences were noted for patients managed with WE vs APR. Review of the literature demonstrated regional trends in surgical management of ARM, with WE favored in the United States and Europe and APR used more frequently in Asia.
ARM remains a highly lethal disease regardless of surgical treatment. Patients who undergo WE and APR have poor outcomes. No convincing evidence exists to favor APR over WE. Despite this, APR continues to be used for primary surgical management, although with decreasing frequency in the United States and Europe in recent years. We feel that surgical management should aim to minimize morbidity. WE should be favored over APR for primary surgical treatment.
Further research should focus on better risk stratification and the role of targeted therapies, radiation therapy, and treatment sequencing. Improving non-surgical therapies will be critical to improving survival for patients with ARM.