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Locoregional Lymphadenectomy in the Surgical Management of Anorectal Melanoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Daniel R. Perez MD, Atthaphorn Trakarnsanga 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 & Martin R. Weiser MD

  2. Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Richard D. Carvajal MD

  3. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Jinru Shia MD

Authors
  1. Daniel R. Perez MD
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  2. Atthaphorn Trakarnsanga MD
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  3. Jinru Shia MD
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  4. Garrett M. Nash MD
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  5. Larissa K. Temple MD
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  6. Philip B. Paty MD
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  7. Jose G. Guillem MD, MPH
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  8. Julio Garcia-Aguilar MD, PhD
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  9. Danielle Bello MD
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  10. Charlotte Ariyan MD
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  11. Richard D. Carvajal MD
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  12. Martin R. Weiser MD
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Corresponding author

Correspondence to Martin R. Weiser MD.

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Perez, D.R., Trakarnsanga, A., Shia, J. et al. Locoregional Lymphadenectomy in the Surgical Management of Anorectal Melanoma. Ann Surg Oncol 20, 2339–2344 (2013). https://doi.org/10.1245/s10434-012-2812-6

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  • DOI: https://doi.org/10.1245/s10434-012-2812-6

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