SURGICAL RESECTION FOR MELANOMA METASTATIC TO THE GASTROINTESTINAL-TRACT

Objective: To evaluate the role of surgery in the survival of patients with melanoma metastatic to the gastrointestinal (GI) tract. Design: Retrospective review. Setting: Tertiary cancer center. Patients: One h undred twenty-four potential surgical candidates with metastatic melan oma in the stomach, small intestine, colon, or rectum. Main Outcome Me asures: Operative morbidity and mortality, relief of presenting sympto ms, and median and 5-year survival. Results: The median disease-free i nterval prior to diagnosis of GI tract metastasis was 23.2 months (ran ge, 1-154 months). Patients typically presented with crampy abdominal pain, symptomatic mass, and/or occult GI tract blood loss. Of the 124 patients, 69 (55%) underwent surgical exploration of the abdomen, 46 ( 66%) had curative resection, and 23 (34%) had a palliative procedure. There was only 1 operative death and 1 major operative complication; 6 7 (97%) of 69 surgical patients experienced postoperative relief of th eir presenting GI tract symptoms. The median survival in patients unde rgoing curative resection was 48.9 months, compared with only 5.4 mont hs and 5.7 months in those undergoing palliative procedures and nonsur gical interventions, respectively. By multivariate analysis, the Z mos t important prognostic factors for long-term survival were complete re section of GI tract metastases and the GI tract as the initial site of distant metastases. Conclusions: Almost all patients with melanoma an d GI tract metastases can have palliation of symptoms by surgical inte rvention with minimal morbidity and mortality. The high 5-year surviva l rate associated with complete surgical resection of GI tract metasta ses indicates that surgery should be strongly considered for this subg roup of patients with melanoma and distant metastatic disease.