Surgery for abdominal metastases of cutaneous melanoma.
The objective of this study was to support our hypothesis that surgical resection of abdominal metastases of melanoma, regardless of symptomatology, could provide prolonged palliation and improved survival. We performed a retrospective chart review at M.D. Anderson Cancer Center. A series of 251 melanoma patients (stages I, II, or III at registration) who developed intraabdominal metastases during follow-up were studied. Altogether, 96 patients underwent 119 laparotomies; 51 underwent endoscopic or percutaneous procedures; and 116 patients were treated medically. Surgery was associated with a median survival of 11 months, significantly longer than that with other treatment (p < 0.001). Tumor was extirpated during 37% of the first laparotomies, and in an additional 33% very good palliation was achieved with incomplete resection. Tumor extirpation was associated with 10-month symptom-free survival (SFS), significantly longer than that with any other approach (p < 0.0001). In the nonsurgically treated patients, good palliation was achieved in 8% to 17% of patients with no complete response. The median SFS after surgery was 5 months, but 23% of patients were symptom-free more than 12 months; 87 patients with minimal symptoms; and 72 severely symptomatic patients underwent surgery. Complete resection was feasible in 42% and 34%, respectively. Surgery was associated with 12 months median survival in both groups. There was a significant survival benefit from surgery in patients with gastrointestinal (GI) tract metastases in contrast to those who had non-GI metastases. For the 96 surgically treated patients, a time interval of more than 4 years between diagnosis of the primary lesion and the abdominal recurrence predicted decreased risk of death (p = 0.038). The 30-day postoperative complication and mortality rates were 19.0% and 3.3%, respectively. Complete surgical resection of melanoma metastases in the abdomen is associated with median and symptom-free survival benefits. Symptomatic and asymptomatic patients benefit equally, especially if abdominal metastases appear more than 4 years after the initial diagnosis and do not involve non-GI viscera. Less than complete resection can provide durable palliation.
Gutman
H
H
Department of Surgical Oncology, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA. hgutman@clalit.org.il
Hess
K R
KR
Kokotsakis
J A
JA
Ross
M I
MI
Guinee
V F
VF
Balch
C M
CM
D000008:Abdominal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary*; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D016019:Survival Analysis