Management of intussusception in patients with melanoma

Matthew C. Perez, James Sun, Clara Farley, Dale Han, Alexander H. Sun, Deepak Narayan, Michael Lowe, Keith A. Delman, Jane L. Messina, Ricardo J. Gonzalez, Vernon K. Sondak, Nikhil I. Khushalani, Jonathan S. Zager

Research output: Contribution to journalArticle

Abstract

Background: Increased cross-sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception. Methods: We performed a multi-institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded. Results: We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre-emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre-emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50% of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum). Conclusion: Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.

Original languageEnglish (US)
JournalJournal of surgical oncology
DOIs
StatePublished - Jan 1 2019

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Intussusception
Melanoma
Meckel Diverticulum

Keywords

  • bowel resection
  • intussusception
  • melanoma
  • metastatic melanoma, surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Perez, M. C., Sun, J., Farley, C., Han, D., Sun, A. H., Narayan, D., ... Zager, J. S. (2019). Management of intussusception in patients with melanoma. Journal of surgical oncology. https://doi.org/10.1002/jso.25393

Management of intussusception in patients with melanoma. / Perez, Matthew C.; Sun, James; Farley, Clara; Han, Dale; Sun, Alexander H.; Narayan, Deepak; Lowe, Michael; Delman, Keith A.; Messina, Jane L.; Gonzalez, Ricardo J.; Sondak, Vernon K.; Khushalani, Nikhil I.; Zager, Jonathan S.

In: Journal of surgical oncology, 01.01.2019.

Research output: Contribution to journalArticle

Perez, MC, Sun, J, Farley, C, Han, D, Sun, AH, Narayan, D, Lowe, M, Delman, KA, Messina, JL, Gonzalez, RJ, Sondak, VK, Khushalani, NI & Zager, JS 2019, 'Management of intussusception in patients with melanoma', Journal of surgical oncology. https://doi.org/10.1002/jso.25393
Perez, Matthew C. ; Sun, James ; Farley, Clara ; Han, Dale ; Sun, Alexander H. ; Narayan, Deepak ; Lowe, Michael ; Delman, Keith A. ; Messina, Jane L. ; Gonzalez, Ricardo J. ; Sondak, Vernon K. ; Khushalani, Nikhil I. ; Zager, Jonathan S. / Management of intussusception in patients with melanoma. In: Journal of surgical oncology. 2019.
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title = "Management of intussusception in patients with melanoma",
abstract = "Background: Increased cross-sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception. Methods: We performed a multi-institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded. Results: We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre-emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre-emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50{\%} of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum). Conclusion: Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.",
keywords = "bowel resection, intussusception, melanoma, metastatic melanoma, surgery",
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AU - Perez, Matthew C.

AU - Sun, James

AU - Farley, Clara

AU - Han, Dale

AU - Sun, Alexander H.

AU - Narayan, Deepak

AU - Lowe, Michael

AU - Delman, Keith A.

AU - Messina, Jane L.

AU - Gonzalez, Ricardo J.

AU - Sondak, Vernon K.

AU - Khushalani, Nikhil I.

AU - Zager, Jonathan S.

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N2 - Background: Increased cross-sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception. Methods: We performed a multi-institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded. Results: We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre-emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre-emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50% of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum). Conclusion: Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.

AB - Background: Increased cross-sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception. Methods: We performed a multi-institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded. Results: We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre-emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre-emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50% of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum). Conclusion: Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.

KW - bowel resection

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