• Akihisa Matsuda, Masao Miyashita, Satoshi Matsumoto, Goro Takahashi, Takeshi Matsutani, Takeshi Yamada, Taro Kishi, and Eiji Uchida.
• *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.
• Ann. Surg.. 2015 Apr 1;261(4):670-7.

ObjectiveTo determine whether the extent of surgery is associated with survival in anorectal malignant melanoma (ARMM).BackgroundARMM 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.MethodsA 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).ResultsThirty-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).ConclusionsAlthough 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.

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