原发性直肠黑色素瘤的手术治疗:更少更好吗?
Michael G Fadel1,2, Hesham S Mohamed3,4, Justin Weir5
1The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK. m.fadel@imperial.ac.uk.
Journal of gastrointestinal cancer
|January 5, 2024
概括
对直肠黑色素瘤 (ARM) 的较少激进的手术可能与广泛的手术提供类似的瘤结果. 这种方法与ANO-uro-genital (AUG) 准则保持一致,有可能降低患者的发病率并保持功能.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 英国的"无尿性生殖器 (AUG) 粘膜黑色素瘤指南"倡导在可行的情况下在阳肠黑色素瘤 (ARM) 中采用较少激进的外科手术策略.
- 本研究报告了遵循这些不那么激进的外科原则的ARM管理的临床经验.
研究的目的:
- 为了评估非直肠黑色素瘤 (ARM) 患者的临床表现,手术干预和瘤结局,用较少激进的手术方法治疗.
- 根据当前的指导方针,评估ARM保守性外科治疗的可行性和有效性.
主要方法:
- 在2014年11月至2023年4月间连续接受手术治疗的15名ARM患者进行了回顾性研究.
- 患者被分为两个手术组:宽局部切除 (WLE,n=9) 和腹腔切除 (APR,n=6).
- 人口,诊断,治疗和瘤结局数据被分析并比较了WLE和APR组之间的数据.
主要成果:
- 患者平均年龄为65.3岁,其中40%为女性. 大多数患者 (60%) 被诊断为I期疾病.
- 在所有情况下都实现了R0利. 与APR (14.0天) 相比,WLE (2.6天) 的平均住院时间显著低于WLE (2.6天) (p=0.032).
- 在WLE (55.5%) 和APR (50.0%) (p=0.707) 之间,局部/远程复发率相似,平均整体存活时间相似 (WLE为38.5个月,APR为26.5个月).
结论:
- 通过不那么激进的手术来实现明显的外科边缘,可能会产生与ARM激进手术相美的瘤结果.
- 这种方法有潜力降低患者的发病率,并保持直肠功能.
- 根据AUG指南的"少就多"原则,ARM的手术管理表明了可接受的结果.
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