title: Locoregional lymphadenectomy in the surgical management of anorectal melanoma.
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.
authors: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Daniel R
authors: DR
authors: Perez
authors: Atthaphorn
authors: A
authors: Trakarnsanga
authors: Jinru
authors: J
authors: Shia
authors: Garrett M
authors: GM
authors: Nash
authors: Larissa K
authors: LK
authors: Temple
authors: Philip B
authors: PB
authors: Paty
authors: Jose G
authors: JG
authors: Guillem
authors: Julio
authors: J
authors: Garcia-Aguilar
authors: Danielle
authors: D
authors: Bello
authors: Charlotte
authors: C
authors: Ariyan
authors: Richard D
authors: RD
authors: Carvajal
authors: Martin R
authors: MR
authors: Weiser
mesh_terms: D000368:Aged; D001005:Anus Neoplasms / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D010525:Peripheral Nerves / Q000473:pathology*; D016016:Proportional Hazards Models; D012007:Rectum; D012189:Retrospective Studies; D017211:Treatment Failure