Metastasectomy for recurrent stage IV melanoma

Background and Objectives: Many patients undergoing complete surgical resec tion of distant metastatic melanoma (American Joint Committee on Cancer [AJ CC] stage IV) develop recurrent disease. We examined whether a second metas tasectomy could prolong the survival of patients with recurrent stage IV me lanoma. Design and Patients: Retrospective review of our 8,750-patient melanoma dat abase identified 211 patients who were rendered clinically free of disease by surgical resection of stage IV metastases during the 23-year study perio d (January 1971 through December 1995). Our study population comprised the 131 patients who developed recurrent stage IV disease and were followed for at least 24 months or until death. Results: The median disease-free interval prior to recurrent stage IV disea se was 8 months (range 0.6-91.8 months). There were 131 tumor-involved anat omic sites; the median number was one (range 1-3). Of these sites, 71 (54.2 %) were soft tissue, 35 (26.7%) were pulmonary, 28 (21.4%) were gastrointes tinal, 23 (17.6%) were cerebral, 13 (9.9%) were skeletal, and 2 (1.5%) were gynecologic. Median survival following treatment for recurrent stage IV me lanoma was 18.2 months after complete metastasectomy, compared with 12.5 mo nths or 5.9 months after a palliative surgical procedure or nonsurgical man agement, respectively. The 5-year survival rate was 20.0% (8/40) for patien ts in the complete surgical metastasectomy group, compared with 7.0% (3/43) and 2.1% (1/48) for those in the palliative surgical and nonsurgical group s, respectively. By multivariate analysis, the two most important prognosti c factors for survival following diagnosis of recurrent stage IV melanoma w ere a prolonged disease-free interval to recurrence (P = 0.0001) and comple te surgical metastasectomy of the recurrence (P = 0.0001). Conclusions: Metastasectomy can prolong the survival of patients with recur rent stage TV melanoma if all clinically evident tumor can be resected. J. Surg. Oncol. 1999:71.209-213. (C) 1999 Wiley-Liss, Inc.