title: A 20-year experience of hepatic resection for melanoma: is there an expanding role?
abstract: BACKGROUND
  Melanoma liver metastasis is most often fatal, with a 4- to 6-month median overall survival (OS). Over the past 20 years, surgical techniques have improved in parallel with more effective systemic therapies. We reviewed our institutional experience of hepatic melanoma metastases.
  
  
  METHODS
  Overall and disease-specific survivals were calculated from hepatic metastasis diagnosis. Potential prognostic factors including primary tumor type, depth, medical treatment response, location, and surgical approach were evaluated.
  
  
  RESULTS
  Among 1,078 patients with melanoma liver metastases treated at our institution since 1991, 58 (5.4%) received surgical therapy (resection with or without ablation). Median and 5-year OS were 8 months and 6.6 %, respectively, for 1,016 nonsurgical patients vs 24.8 months and 30%, respectively, for surgical patients (p < 0.001). Median OS was similar among patients undergoing ablation (with or without resection) relative to those undergoing surgery alone. On multivariate analysis of surgical patients, completeness of surgical therapy (hazard ratio [HR] 3.4, 95% CI 1.4 to 8.1, p = 0.007) and stabilization of melanoma on therapy before surgery (HR 0.38, 95% CI 0.19 to 0.78, p = 0.008) predicted OS.
  
  
  CONCLUSIONS
  In this largest single-institution experience, patients selected for surgical therapy experienced markedly improved survival relative to those receiving only medical therapy. Patients whose disease stabilized on medical therapy enjoyed particularly favorable results, regardless of the number or size of their metastases. The advent of more effective systemic therapy in melanoma may substantially increase the fraction of patients who are eligible for surgical intervention, and this combination of treatment modalities should be considered whenever it is feasible in the context of a multidisciplinary team.
authors: Department of Surgical Oncology, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA. Electronic address: mark.faries@jwci.org.
authors: Mark B
authors: MB
authors: Faries
authors: Department of Surgical Oncology, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA.
authors: Anna
authors: A
authors: Leung
authors: Department of Surgical Oncology, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA.
authors: Donald L
authors: DL
authors: Morton
authors: Department of Surgical Oncology, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA.
authors: Danielle
authors: D
authors: Hari
authors: Department of Biostatistics, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA.
authors: Ji-Hey
authors: JH
authors: Lee
authors: Department of Biostatistics, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA.
authors: Myung-shin
authors: MS
authors: Sim
authors: Department of Surgical Oncology, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA.
authors: Anton J
authors: AJ
authors: Bilchik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome