World Journal of Surgery

, Volume 31, Issue 1, pp 171–174

Selected Patients with Metastatic Melanoma May Benefit from Liver Resection

  • Paulo Herman
  • Marcel Autran C. Machado
  • André Luis Montagnini
  • Luiz A. C. D’Albuquerque
  • William A. Saad
  • Marcel C. C. Machado
Article

Abstract

Background

In the last few years there has been expanding use of hepatic resection for non-colorectal metastases. The purpose of this study is to evaluate the experience of liver resection for patients with metastatic melanoma.

Methods

Eighteen patients with metastatic melanoma were explored for possible surgical resection. All patients fitted the following criteria: absence of extra-hepatic disease after evaluation with CT/MRI and FDG-PET scans; disease-free interval longer than 24 months after the resection of the primary melanoma; presumed completely resectable lesions; absence of clinical co-morbidities.

Results

Liver resection was performed in 10 patients; 8 out of 18 presented with irresectable tumors and/or peritoneal metastases and were not operated. One patient presented with postoperative biliary fistula and was conservatively managed. No other complications or postoperative mortality were observed. After a mean follow-up of 25.4 months, 5 patients are alive and without evidence of recurrence. Overall median survival was 22 months; overall survival and disease-free survival were 70% and 50% respectively.

Conclusions

Resection of liver metastases from melanoma in a selected group of patients may increase survival. Exploratory laparoscopy should be included in the preoperative armamentarium of diagnostic tools.

References

  1. 1.
    Elias D, Albuquerque AC, Eggenspieler P, et al. Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients. J Am Coll Surg 1998;187:487–493PubMedCrossRefGoogle Scholar
  2. 2.
    Hemming AW, Sielaff TD, Gallinger S, et al. Hepatic resection of noncolorectal nonneuroendocrine metastases. Liver Transpl 2000;6:97–101PubMedGoogle Scholar
  3. 3.
    Weitz J, Blumgart LH, Fong Y, et al. Partial hepatectomy for metastases from noncolorectal, nonneuroendocrine carcinoma. Ann Surg 2005;241:269–276PubMedCrossRefGoogle Scholar
  4. 4.
    Laurent C, Rullier E, Feyler A, et al. Resection of noncolorectal and nonneuroendocrine liver metastases: late metastases are the only chance of cure. World J Surg 2001;25:1532–1536PubMedGoogle Scholar
  5. 5.
    Rose DM, Essner R, Hughes TMD, et al. Surgical resection for metastatic melanoma to the liver: the John Wayne Cancer Institute and Sydney Melanoma Unit experience. Arch Surg 2001;136:950–955PubMedCrossRefGoogle Scholar
  6. 6.
    Salmon RJ, Levy C, Plancher C, et al. Treatment of liver metastases from uveal melanoma by combined surgery–chemotherapy. Eur J Surg Oncol 1998;24:127–130PubMedCrossRefGoogle Scholar
  7. 7.
    Mondragon-Sanchez R, Barrera-Franco JL, Cordoba-Gutierrez H, et al. Repeat hepatic resection for recurrent metastatic melanoma. Hepatogastroenterology 1999;46:459–461PubMedGoogle Scholar
  8. 8.
    Hsueh EC, Essner R, Foshag LJ, et al. Prolonged survival after complete resection of metastases from intraocular melanoma. Cancer 2004;100:122–129PubMedCrossRefGoogle Scholar
  9. 9.
    Wong SL, Coit DG. Role of surgery in patients with stage IV melanoma. Curr Opin Oncol 2004;16:155–160PubMedCrossRefGoogle Scholar
  10. 10.
    Allen PJ, Coit DG. The surgical management of metastatic melanoma. Ann Surg Oncol 2002;9:762–770PubMedCrossRefGoogle Scholar
  11. 11.
    Branum GD, Epstein RE, Leight GS, et al. The role of resection in the management of melanoma metastatic to the adrenal gland. Surgery 1991;109:127–131PubMedGoogle Scholar
  12. 12.
    Mosimann F, Fontolliet C, Genton A, et al. Resection of metastases to the alimentary tract from malignant melanoma. Int Surg 1982;67:257–260PubMedGoogle Scholar
  13. 13.
    Lejeune FJ, Lienard D, Sales F, et al. Surgical management of distant melanoma metastases. Semin Surg Oncol 1992;8:381–391PubMedGoogle Scholar
  14. 14.
    Wong JH, Euhus DM, Morton DL. Surgical resection for metastatic melanoma to the lung. Arch Surg 1988;123:1091–1095PubMedGoogle Scholar
  15. 15.
    De Wilt JHW, McCarthy WH, Thompson JF. Surgical treatment of splenic metastases in patients with melanoma. J Am Coll Surg 2003;197:38–43PubMedCrossRefGoogle Scholar
  16. 16.
    Foster JH. Survival after liver resection for secondary tumors. Am J Surg 1978;135:389–394PubMedCrossRefGoogle Scholar
  17. 17.
    Stas M, Stroobants S, Dupont P. 18-FDG PET scan in the staging of recurrent melanoma: additional value and therapeutic impact. Melanoma Res 2002;12:479–490PubMedCrossRefGoogle Scholar
  18. 18.
    Clark PB, Victoria Soo BS, Kraas J, et al. Futility of fluorodeoxyglucose F-18 positron emission tomography in initial evaluation of patients with T2 to T4 melanoma. Arch Surg 2006;141:284–288PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Paulo Herman
    • 1
    • 2
    • 3
  • Marcel Autran C. Machado
    • 1
  • André Luis Montagnini
    • 1
  • Luiz A. C. D’Albuquerque
    • 2
  • William A. Saad
    • 2
  • Marcel C. C. Machado
    • 1
  1. 1.Department of Abdominal SurgeryA.C. Camargo Cancer HospitalSão PauloBrazil
  2. 2.Department of GastroenterologyUniversity of São Paulo Medical SchoolSão PauloBrazil
  3. 3.São PauloBrazil

Personalised recommendations