Surgical Management for Stage, I, II Anorectal Melanoma : an Experience of a Single Institution

肛門直腸黑色素瘤是罕見且預後極差之腫瘤，其手術治療仍具爭議性，本文之目的是在探討，對於第一及第二期肛門直腸黑色素瘤，腹部會陰切除術(APR, abdominoperineal resection)是否較局部切除(local excision)?佳。本研究回溯追蹤從1976年至2007年間，於林口長庚醫院接受手術治療之16位肛門直腸黑色素瘤患者，其中10位?第一期或第二期之病患，我們比較其手術方法與預後。我們發現第一期之肛門直腸黑色素瘤患者之預後，較第二期之患者?佳，且對於早期可切除之肛門直腸黑色素瘤（第一期、腫瘤較小、侵犯深度較淺、腫瘤厚度較薄），腹部會陰切除術是較佳之手術選擇。我們認?第一期之肛門直腸黑色素瘤，伴隨腫瘤小於2 cm、侵犯深度不超過黏膜下層、腫瘤厚度小於8 mm者，仍應以腹部會陰切除術(APR)作?根除性之于術。
Objective: The aim of our study was to determine whether APR (abdominoperineal resection) was the better choice for stage Ⅰ and stage Ⅱ anorectal melanoma. Methods: A retrospective study of 16 patients from Chang Gung Memorial Hospital between 1976 and 2007 was made. Ten of them had stage Ⅰ and stage Ⅱ diseases. We analyzed their surgical methods and outcomes. Results: Stage Ⅰ patients had a better outcome than stage Ⅱ patients. APR was the preferred curative surgical method for anorectal melanoma (stage Ⅰ, smaller tumor size, shallower invasion depth, and thinner tumor thickness). Conclusions: We recommend APR as curative surgery for stage Ⅰ anorectal melanoma with tumor size of less than 2 cm, tumor invasion depth not surpassing the submucosal layer, and tumor thickness of less than 8 mm.