Surgery for melanoma metastatic to the gastrointestinal tract

被引：115

作者：

Agrawal S. ^{[1
]}

Yao T.-J. ^{[2
]}

Coit D.G. ^{[3
,4
]}

机构：

[1] Department of Surgery, Columbia Univ. Coll. Phys. Surgs., New York, NY

[2] Department of Biostatistics, Mem. Sloan-Kettering Cancer Center, New York, NY

[3] Department of Surgery, Mem. Sloan-Kettering Cancer Center, New York, NY

[4] Dept. of Surgery, Mem. Sloan-Kettering Cancer Center, New York, NY 10021

来源：

Annals of Surgical Oncology | 1999年 / 6卷 / 4期

关键词：

Gastrointestinal tract; Melanoma; Surgery;

D O I：

10.1007/s10434-999-0336-5

中图分类号：

学科分类号：

摘要：

Background: Gastrointestinal (GI) metastasis from melanoma has a dismal prognosis with few long-term survivors. We evaluated the role of operative intervention for melanoma metastases to the GI tract and attempted to identify prognostic factors to improve selection of patients for surgery. Methods: Between 1977 and 1997, 68 of the 7965 patients with melanoma admitted to Memorial Sloan-Kettering Cancer Center underwent surgical exploration for melanoma metastatic to the GI tract. Characteristics of the primary tumor, regional lymph nodes, and metastatic pattern were reviewed. Data concerning the presenting signs and symptoms, laboratory values, operative findings, extent of surgical resection, recurrence pattern, and survival were analyzed. Results: The most common presenting clinical features included anemia (n = 41; 60%) or abdominal pain (n = 40; 59%). The most frequently involved portion of the GI tract was the small bowel (n = 62; 91%), and the most common operative procedure was small bowel resection (n = 54; 79%). Postoperative mortality and morbidity were 2.9% (n = 2) and 8.8% (n = 6), respectively. Presenting symptoms were relieved in 90% of patients (n = 61). Median survival for all 68 patients following operative intervention was 8.2 months, with 18% survival at 5 years. By multivariate analysis, complete resection rendering the patient free of all identifiable disease (n = 19, median survival 14.9 months, 38% survival at 5 years) and a low preoperative serum lactate dehydrogenase (LDH) (n = 28, median survival 13.6 months, 35% survival at 5 years) were identified as independent favorable prognostic factors for survival. Conclusions: Operative intervention for melanoma metastatic to the GI tract is recommended for palliative reasons and can be performed with low morbidity and mortality. It is associated with prolonged survival in patients rendered free of all identifiable disease following surgical resection and in those with a low preoperative serum LDH.

引用

页码：336 / 344

页数：8

共 30 条

[1]

De La Monte S.M., Moore G.W., Hutchins G.M., Patterned distribution of metastases from malignant melanoma in humans, Cancer Res, 43, pp. 3427-3433, (1983)

[2]

Patel J.K., Didolkar M.S., Pickren J.W., Moore R.H., Metastatic pattern of malignant melanoma. A study of 216 autopsy cases, Am J Surg, 135, pp. 807-810, (1978)

[3]

Reintgen D.S., Thompson W., Garbutt J., Seigler H.F., Radiologic, endoscopic and surgical considerations of melanoma metastatic to the gastrointestinal tract, Surgery, 95, pp. 635-639, (1984)

[4]

Ihde J.K., Coit D.G., Melanoma metastatic to stomach, small bowel or colon, Am J Surg, 162, pp. 208-211, (1991)

[5]

Caputy G.G., Donohue J.H., Goellner J.R., Weaver A.L., Metastatic melanoma of the gastrointestinal tract, Arch Surg, 126, pp. 1353-1358, (1991)

[6]

Khadra M.H., Thompson J.F., Milton G.W., McCarthy W.H., The justification of surgical treatment of metastatic melanoma of the gastrointestinal tract, Surg Gynecol Obstet, 171, pp. 413-416, (1990)

[7]

Ricaniadis N., Konstadoulakis M.M., Walsh D., Karakousis C.P., Gastrointestinal metastases from malignant melanoma, Surg Oncol, 4, pp. 105-110, (1995)

[8]

Ollila D.W., Essner R., Wanek L.A., Morton D.L., Surgical resection for melanoma metastatic to the gastrointestinal tract, Arch Surg, 131, pp. 975-980, (1996)

[9]

Branum G.D., Seigler H.F., Surgical intervention in the management of intestinal metastases from malignant melanoma, Am J Surg, 162, pp. 428-431, (1991)

[10]

Jorge E., Harvey H.A., Simmonds M.A., Lipton A., Joehl R.J., Symptomatic malignant melanoma of the gastrointestinal tract: Operative treatment and survival, Ann Surg, 199, pp. 328-331, (1986)

← 1 2 3 →