| Objective To analyze and summarize the basic information,clinical symptoms,pathological characteristics and operation conditions of anorectal malignant melanoma,so as to explore the influence of these factors on prognosis.Methods 26 patients with anorectal malignant melanoma diagnosed and treated by surgery at Qilu Hospital of Shandong University from 2004 to 2018 were retrospectively analyzed.The clinical features,surgical methods,and case characteristics of the patients were analyzed.Factors associated with the patient’s survival were analyzed..Results A total of 26 patients were enrolled in this study,including 11 men(42.3%),15 women(57.7%),the average age was 62.00±11.576 years old,the oldest patient was 80 years old,the youngest patient was 40 years old,and the median age was 64 years old,with an average duration of 4.58±3.667 months.Among the 19 patients(73.1%)who had main complaints with bloody stools,anus bulge occurred in 17 cases,accounting for 65.4%;stool frequency increased in 12 cases,accounting for 46.2%;abdominal pain occurred in 7 cases,accounting for 26.9%;tenesmus appeared in 6 cases,accounting for 23.1%;bloating occurred in 4 patients,The percentage accounted for 15.4%;about 3 patients(11.5%)had difficulty in defecation.All 26 patients underwent surgical treatment,of which 19 cases(73.1%)were treated with APR surgery,4(15.4%)underwent WLE surgery,and 3(11.5%)were treated by ELAPE.Postoperative pathology showed that the tumor was located in the mucosa and submucosa in 11 cases(42.3%),located in the muscular layer in 9 cases(34.6%),and infiltration of the adventitia or surrounding tissue in 6 cases(23.1%).All 26 patients had negative surgical margins.The tumor was located in the anal canal in 8 cases(30.8%),located in the anal-rectal junction in 12 cases(46.2%),and located in the rectum in 6 cases(23.1%).The postoperative pathological results showed that 12 cases(46.2%)had local lymph node metastasis.The clinical stages of postoperative patients were 14(53.8%),8 cases(30.8%)in stage Ⅱ,and 4 cases(15.4%)in stage Ⅲ.Follow-up was ended with death or loss of visit.Of the 26 patients,6 cases(23.1%)were still alive,17 cases(65.4%)were died,and 3 cases(11.5%)were lost visit.The 1-year survival rate of the statistical patients was 78.8%,the 3-year survival rate was 12.9%,and the 5-year survival rate was 6.4%.Univariate analysis with patient death as the prognostic endpoint showed that there was no significant difference between the three groups of patients receiving APR,WLE,and ELAPE(P=0.257).By univariate analysis,the size of the tumor,depth of tumor invasion,presence or absence of regional lymph node metastasis,and tumor stage were associated with prognosis(P= 0.027,0.001,0.001,0.000,respectively).The above factors using COX regression multivariate analysis showed that the clinical stage of the tumor was an independent risk factor for the prognosis of anorectal malignant melanoma(RR =9.774,95%CI:2.664-35.865,P = 0.001).Conclusion Anorectal malignant melanoma has no specific symptoms,high invasiveness,and is easily misdiagnosed.The 5-year survival rate is low.Surgical treatment is the most important method.In the early stage,stool blood and anus bulge are more common.The vast majority were located in the lower rectum and anal canal.Multivariate survival analysis showed that the clinical stage of postoperative tumors was the key factor determining the survival of anorectal malignant melanoma patients.The surgical treatment was the main treatment method.The three surgical methods APR,WLE,ELAPE had no significant effect on the prognosis.R0 resection is the most basic pursuit of surgery.On the basis of R0 resection,the quality of life of patients should be improved as much as possible.WLE can be used as the first choice for patients with early anorectal malignant melanoma,and APR surgery can be used as a second-line surgical approach for the patients with local infiltration or recurrence after WLE surgery.ELAPE surgery as a new surgical method,and its impact on the prognosis is still need to be explored. |
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