Surgical resection for metastatic melanoma to the liver - The John Wayne Cancer Institute and Sydney Melanoma Unit Experience

Hypothesis: Metastatic melanoma to the liver is not incurable; complete sur gical resection can achieve longterm 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 resect ion has not been generally accepted as a therapeutic option, as most patien ts will have other sites of disease that limit their survival to a median o f only 4 to 6 months. However, there is little information on outcomes foll owing resection in those patients with disease limited to the liver. Patients and Methods: Review of the prospective melanoma databases at the J ohn Wayne Cancer Institute, Santa Monica, Calif, and the Sydney Melanoma Un it, Sydney, Australia, identified 1750 patients with hepatic metastases, of whom 34 (2%) underwent exploration with intent to resect the metastases. P rognostic 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%) underwen t hepatic resection and 10 (29%) underwent exploration but not resection. E ighteen patients (75%) underwent complete surgical resection, while the rem aining 6 underwent palliative or debulking procedures with incomplete resec tion. 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 c m). 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 resec tion were 12 months (range, 0-147 months) and 28 months (range, 2-147 month s), respectively. Five-year DFS and OS in this group were 12% and 29%. Macr oscopically, complete resection of disease (P=.001) and histologically nega tive resection margins (P=.03) significantly improved DFS by univariate ana lysis. Patients rendered surgically free of disease also tended to have imp roved OS (P=.06). Median OS was 28 months for patients who underwent surgic al resection compared with 4 months fur 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, w ho can hr rendered free of disease should he considered for complete surgic al resection, as their prognosis is otherwise dismal.