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Surgical Resection for Metastatic Melanoma to the Liver
The John Wayne Cancer Institute and Sydney Melanoma Unit Experience
D. Michael Rose, MD;
Richard Essner, MD;
T. Michael D. Hughes, MBBS;
Paul C. Y. Tang, MBBS;
Anton Bilchik, MD;
Leslie A. Wanek, DrPH;
John F. Thompson, MD;
Donald L. Morton, MD
Arch Surg. 2001;136:950-955.
Hypothesis Metastatic melanoma to the liver is not incurable; complete surgical resection can achieve long-term survival in selected patients.
Background Metastases to the liver are diagnosed in 10% to 20% of patients with American Joint Committee on Cancer stage IV melanoma. Surgical resection has not been generally accepted as a therapeutic option, as most patients will have other sites of disease that limit their survival to a median of only 4 to 6 months. However, there is little information on outcomes following resection in those patients with disease limited to the liver.
Patients and Methods Review of the prospective melanoma databases at the John Wayne Cancer Institute, Santa Monica, Calif, and the Sydney Melanoma Unit, Sydney, Australia, identified 1750 patients with hepatic metastases, of whom 34 (2%) underwent exploration with intent to resect the metastases. Prognostic factors within the group of patients who underwent resection were examined by univariate and multivariate analysis, and median disease-free survival (DFS) and overall survival (OS) were calculated.
Results Of 34 patients undergoing exploratory celiotomy, 24 (71%) underwent hepatic resection and 10 (29%) underwent exploration but not resection. Eighteen patients (75%) underwent complete surgical resection, while the remaining 6 underwent palliative or debulking procedures with incomplete resection. The operative resections included lobectomy (n=14), segmentectomy (4), nonanatomic resection (5), and extended lobectomy (1). The median number of resected lesions was 1, and median lesion size was 5 cm (range, 0.7-22 cm). The median disease-free interval between initial diagnosis of melanoma and development of hepatic metastases was 58 months (range, 0-264 months). Median DFS and OS estimates in the 24 patients who underwent surgical resection were 12 months (range, 0-147 months) and 28 months (range, 2-147months), respectively. Five-year DFS and OS in this group were 12% and 29%. Macroscopically, complete resection of disease (P = .001) and histologically negative resection margins (P = .03) significantly improved DFS by univariate analysis. Patients rendered surgically free of disease also tended to have improved OS (P = .06). Median OS was 28 months for patients who underwent surgical resection compared with 4 months for patients who underwent exploration only (P<.001).
Conclusions Resection of metastatic melanoma to the liver may improve DFS and OS in selected patients, similar to resection of other metastatic sites. Therefore, patients with limited metastatic sites, including the liver, who can be rendered free of disease should be considered for complete surgical resection, as their prognosis is otherwise dismal.
From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif (Drs Rose, Essner, Bilchik, Wanek, and Morton); and Sydney Melanoma Unit, Royal Prince Alfred Hospital, and the Department of Surgery, University of Sydney, Sydney, Australia (Drs Hughes, Tang, and Thompson).
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