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Surgery of small bowel melanoma metastases in the era of efficient medical therapies: a retrospective cohort study.
Melanoma Research ( IF 2.2 ) Pub Date : 2021-05-25 , DOI: 10.1097/cmr.0000000000000737
Nausicaa Malissen 1 , Georges Farvacque 2 , Pauline Duconseil 2 , David Jérémie Birnbaum 2 , Claire Falque 3 , Nicolas Macagno 4 , Jean-Jacques Grob 1 , Caroline Gaudy-Marqueste 1 , Vincent Moutardier 2
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Surgery of small bowel melanoma metastases has to be reconsidered in the era of targeted treatments and immunotherapy. To retrospectively assess context and outcomes of small bowel melanoma metastases resections. All consecutive melanoma patients who underwent resection of small bowel metastases between 2011 and 2017, in a single referral center, were retrospectively analyzed through melanoma-specific survival (MSS). A total of 20 patients were included with a 47.8 months median follow-up. Before small bowel surgery, eight patients (40%) were asymptomatic while seven had anemia and five patients had abdominal pain. All resections were decided on tumor boards except for three surgeries performed in the emergency setting. In the whole cohort, MSS was 89.5 months with 50% of patients alive at the study endpoint. We classified surgical indications in three groups: (1) surgery as a pivotal treatment for mono- or oligo-metastases limited to the small bowel (n = 6); (2) salvage surgery for symptomatic patients in order to preserve their chances to switch to an active line of medical treatment (n = 8); and (3) surgery of small bowel dissociated metastatic progression for patients otherwise controlled (n = 6), aiming at keeping patients with the same treatment or active follow-up. In these three situations, the objective of surgery was usually met, and most patients had a long median MSS after surgery: 70.3 months, 89.5 months and 72.4 months, respectively. Although medical treatments have dramatically improved survival in metastatic melanoma, surgical control of life-threatening localization like small bowel metastases is often a condition for long survival.

中文翻译:

有效药物治疗时代小肠黑色素瘤转移的手术:一项回顾性队列研究。

在靶向治疗和免疫治疗时代,必须重新考虑小肠黑色素瘤转移的手术。回顾性评估小肠黑色素瘤转移切除的背景和结果。通过黑色素瘤特异性生存率 (MSS) 对 2011 年至 2017 年间在单一转诊中心接受小肠转移瘤切除术的所有连续黑色素瘤患者进行回顾性分析。中位随访时间为 47.8 个月,共纳入 20 名患者。小肠手术前,8 名患者(40%)没有症状,7 名患者出现贫血,5 名患者出现腹痛。除三例在紧急情况下进行的手术外,所有切除手术均由肿瘤委员会决定。在整个队列中,MSS 为 89.5 个月,其中 50% 的患者在研究终点时存活。我们将手术适应症分为三组:(1)手术作为仅限于小肠的单转移或寡转移的关键治疗(n = 6);(2) 对有症状的患者进行挽救手术,以保留他们转入积极治疗方案的机会(n = 8);(3) 对其他控制的患者(n = 6)进行小肠游离转移进展手术,旨在使患者保持相同的治疗或积极随访。这三种情况通常都能达到手术目的,大多数患者术后中位 MSS 较长:分别为 70.3 个月、89.5 个月和 72.4 个月。尽管药物治疗已显着提高了转移性黑色素瘤的生存率,但对小肠转移等危及生命的局部进行手术控制通常是长期生存的一个条件。
更新日期:2021-05-29
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