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 after complete resection of pulmonary and hollow viscus gastrointestinal metastases. We hypothesized that patients with metastatic disease to intra-abdominal 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 combination 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). Disease-free survival (DFS) was a secondary outcome measure.


RESULTS
Sixty patients underwent adrenalectomy, hepatectomy, splenectomy, or pancreatectomy. Median OS was significantly improved after complete versus incomplete resections, but median OS after complete resection was not significantly different for single-site versus synchronous multisite metastases. The 5-year survival in the group after complete resection was 24%, whereas in the incomplete resection group, there were no 5-year survivors. Median DFS after complete resection was 15 months. Of note, the 2-year DFS after complete resection was 53% for synchronous multi-site metastases versus 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 not seem to affect the OS after complete resection.
Wood
T F
TF
John Wayne Cancer Institute, Santa Monica, California 90404, USA.
DiFronzo
L A
LA
Rose
D M
DM
Haigh
P I
PI
Stern
S L
SL
Wanek
L
L
Essner
R
R
Morton
D L
DL
D000008:Abdominal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012042:Registries; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D013160:Splenic Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome