title: Abdominoperineal resection provides better local control but equivalent overall survival to local excision of anorectal malignant melanoma: a systematic review.
abstract: OBJECTIVE
  To determine whether the extent of surgery is associated with survival in anorectal malignant melanoma (ARMM).
  
  
  BACKGROUND
  ARMM is a rare and highly malignant neoplasm with unfavorable prognosis. The optimal surgical management, abdominoperineal resection (APR) or local excision (LE), has been long debated, but conclusive evidence has not been obtained.
  
  
  METHODS
  A comprehensive electronic literature search was performed to identify studies evaluating survival between APR and LE for ARMM. The main outcome measures were overall survival, relapse-free survival, and local recurrence. A meta-analysis was performed using the random-effects models to calculate the odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Thirty-one studies, with a total of 1006 patients [544 (54.1%) APR and 462 (45.9%) LE], were included. Meta-analyses showed that overall survival (OR, 1.14; 95% CI, 0.74-1.76; P = 0.54) and relapse-free survival (OR, 0.95; 95% CI, 0.43-2.09; P = 0.89) did not differ significantly between the APR and LE groups. APR significantly reduced local recurrence compared with LE (OR, 0.18; 95% CI, 0.09-0.36; P < 0.00001).
  
  
  CONCLUSIONS
  Although several limitations, such as inclusion of only retrospective studies with relatively small sample size and selection biases for surgical procedure, are involved, this meta-analysis suggested that APR has no survival benefit; however, APR confers better local control than LE. Given that local failures after LE could be managed by salvage surgery, minimizing morbidity and maximizing quality of life should be the focus in surgical treatment of ARMM.
authors.affiliation: *Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan †Department of Gastroenterological Surgery, Nippon Medical School, Tokyo, Japan ‡Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Matsuda
authors.forename: Masao
authors.initials: M
authors.lastname: Miyashita
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Goro
authors.initials: G
authors.lastname: Takahashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsutani
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.forename: Taro
authors.initials: T
authors.lastname: Kishi
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D001005:Anus Neoplasms / Q000401:mortality / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000401:mortality*; D006801:Humans; D008545:Melanoma / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate