Does complete, resection of melanoma metastatic to solid intra-abdominal organs improve survival?

Background: Patients with distant melanoma metastases have median survivals of 4 to 8 months. Previous studies have demonstrated improved survival aft er complete resection of pulmonary and hollow viscus gastrointestinal metas tases. We hypothesized that patients with metastatic disease to intra-abdom inal solid organs might also benefit from complete surgical resection. Methods: A prospectively acquired database identified patients treated for melanoma metastatic to the liver, pancreas, spleen, adrenal glands, or a co mbination of these from 1971 to 2000. The primary intervention was complete or incomplete surgical resection of intra-abdominal solid-organ metastases , and the main outcome measure was postoperative overall survival (OS). Dis ease-free survival (DFS) was a secondary outcome measure. Results:: Sixty patients underwent adrenalectomy, hepatectomy, splenectomy, or pancreatectomy. Median OS was significantly improved after complete ver sus incomplete resections, but median OS after complete resection was, not significantly different for single-site versus synchronous multisite metast ases. The 5-year survival in the, group after complete resection was 24%, w hereas in the incomplete resection group, there were no 5-year survivors. M edian DFS after complete resection was 15 months. Of note, the 2-year DFS a fter complete resection was 53% for synchronous multi-site metastases versu s 26% for single-site metastases. Conclusions: In highly selected patients with melanoma metastatic to intra- abdominal solid organs, aggressive attempts at complete surgical resection may improve OS. It is important that the number of metastatic sites does no t seem to affect the OS after complete resection.