Advertisement

Annals of Surgical Oncology

, Volume 6, Issue 4, pp 336–344 | Cite as

Surgery for Melanoma Metastatic to the Gastrointestinal Tract

  • Shefali Agrawal
  • Tzy-Jyun Yao
  • Daniel G. Coit
Original Article

Abstract

Background: Gastrointestinal (GI) metastasis from melanoma has a dismal prognosis with few long-term survivors. We evaluated the role of operative intervention for melanoma metastases to the GI tract and attempted to identify prognostic factors to improve selection of patients for surgery.

Methods: Between 1977 and 1997, 68 of the 7965 patients with melanoma admitted to Memorial Sloan-Kettering Cancer Center underwent surgical exploration for melanoma metastatic to the GI tract. Characteristics of the primary tumor, regional lymph nodes, and metastatic pattern were reviewed. Data concerning the presenting signs and symptoms, laboratory values, operative findings, extent of surgical resection, recurrence pattern, and survival were analyzed.

Results: The most common presenting clinical features included anemia (n = 41; 60%) or abdominal pain (n = 40; 59%). The most frequently involved portion of the GI tract was the small bowel (n = 62; 91%), and the most common operative procedure was small bowel resection (n = 54; 79%). Postoperative mortality and morbidity were 2.9% (n = 2) and 8.8% (n = 6), respectively. Presenting symptoms were relieved in 90% of patients (n = 61). Median survival for all 68 patients following operative intervention was 8.2 months, with 18% survival at 5 years. By multivariate analysis, complete resection rendering the patient free of all identifiable disease (n = 19, median survival 14.9 months, 38% survival at 5 years) and a low preoperative serum lactate dehydrogenase (LDH) (n = 28, median survival 13.6 months, 35% survival at 5 years) were identified as independent favorable prognostic factors for survival.

Conclusions: Operative intervention for melanoma metastatic to the GI tract is recommended for palliative reasons and can be performed with low morbidity and mortality. It is associated with prolonged survival in patients rendered free of all identifiable disease following surgical resection and in those with a low preoperative serum LDH.

Key Words

Gastrointestinal tract Melanoma Surgery 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    de la Monte SM, Moore GW, Hutchins GM. Patterned distribution of metastases from malignant melanoma in humans. Cancer Res 1983;43:3427–3433.PubMedGoogle Scholar
  2. 2.
    Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg 1978;135:807–810.PubMedGoogle Scholar
  3. 3.
    Reintgen DS, Thompson W, Garbutt J, Seigler HF. Radiologic, endoscopic and surgical considerations of melanoma metastatic to the gastrointestinal tract. Surgery 1984;95:635–639.PubMedGoogle Scholar
  4. 4.
    Ihde JK, Coit DG. Melanoma metastatic to stomach, small bowel or colon. Am J Surg 1991;162:208–211.PubMedGoogle Scholar
  5. 5.
    Caputy GG, Donohue JH, Goellner JR, Weaver AL. Metastatic melanoma of the gastrointestinal tract. Arch Surg 1991;126:1353–1358.PubMedGoogle Scholar
  6. 6.
    Khadra MH, Thompson JF, Milton GW, McCarthy WH. The justification of surgical treatment of metastatic melanoma of the gastrointestinal tract. Surg Gynecol Obstet 1990;171:413–416.PubMedGoogle Scholar
  7. 7.
    Ricaniadis N, Konstadoulakis MM, Walsh D, Karakousis CP. Gastrointestinal metastases from malignant melanoma. Surg Oncol 1995;4:105–110.PubMedCrossRefGoogle Scholar
  8. 8.
    Ollila DW, Essner R, Wanek LA, Morton DL. Surgical resection for melanoma metastatic to the gastrointestinal tract. Arch Surg 1996;131:975–980.PubMedGoogle Scholar
  9. 9.
    Branum GD, Seigler HF. Surgical intervention in the management of intestinal metastases from malignant melanoma. Am J Surg 1991;162:428–431.PubMedGoogle Scholar
  10. 10.
    Jorge E, Harvey HA, Simmonds MA, Lipton A, Joehl RJ. Symptomatic malignant melanoma of the gastrointestinal tract: operative treatment and survival. Ann Surg 1986;199:328–331.CrossRefGoogle Scholar
  11. 11.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481.Google Scholar
  12. 12.
    Peto R, Pike MC, Armitage P. Design and analysis of randomized clinical trials requiring prolonged observations of each patient, II: analysis and examples. Br J Cancer 1977;35:1–39.PubMedGoogle Scholar
  13. 13.
    Hochberg Y, Hamhane AC. Introduction. In: Multiple comparison procedures. New York: John Wiley & Sons, 1987:1–16.Google Scholar
  14. 14.
    McDermott VG, Low VHS, Keogan MT, Lawrence JAL, Paulson EK. Malignant melanoma metastatic to the gastrointestinal tract. Am J Radiol 1996;166:809–813.Google Scholar
  15. 15.
    Klaase JM, Kroon BBR. Surgery for melanoma metastatic to the gastrointestinal tract. Br J Surg 1990;77:60–61.PubMedGoogle Scholar
  16. 16.
    Barth A, Wanek LA, Morton DL. Prognostic factors in 1,521 melanoma patients with distant metastases. J Am Coll Surg 1995;181:193–201.PubMedGoogle Scholar
  17. 17.
    Karakousis CP, Velez A, Driscoll DL, Takita H. Metastatectomy in malignant melanoma. Surgery 1994;115:295–302.PubMedGoogle Scholar
  18. 18.
    Hena MA, Emrich LJ, Nambisan RN, Karakousis CP. Effect of surgical treatment on Stage IV melanoma. Am J Surg 1987;153:270–275.PubMedGoogle Scholar
  19. 19.
    Overett TK, Shiu MH. Surgical treatment of distant metastatic melanoma. Cancer 1985;56:1222–1230.PubMedGoogle Scholar
  20. 20.
    Popat U, Przepiork D, Champlin R, et al. High-dose chemotherapy for relapsed and refractory diffuse large B-cell lymphoma: Mediastinal localization predicts for a favorable outcome. J Clin Oncol 1998;16:63–69.PubMedGoogle Scholar
  21. 21.
    International Germ Cell Cancer Collaborative Group. International germ cell consensus classification: A prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol 1997;15:594–603.Google Scholar
  22. 22.
    Aparicio J, Munarriz B, Pastor M, et al. Long-term follow-up and prognostic factors in Ewing’s sarcoma. A multivariate analysis of 116 patients from a single institution. Oncology 1998;55:20–26.PubMedGoogle Scholar
  23. 23.
    Ferrari S, Bacci G, Picci P, et al. Long-term follow-up and postrelapse survival in patients with non-metastatic osteosarcoma of the extremity treated with neoadjuvant chemotherapy. Ann Oncol 1997;8:765–771.PubMedGoogle Scholar
  24. 24.
    Maestu I, Pastor M, Gomez-Codina J, et al. Pretreatment prognostic factors for survival in small-cell lung cancer: A new prognostic index and validation of three known prognostic indices in 341 patients. Ann Oncol 1997;8:547–553.PubMedGoogle Scholar
  25. 25.
    Herndon JE II, Green MR, Chahinian AP, Corson JM, Suzuki Y, Vogelzang NJ. Factors predictive of survival among 337 patients with mesothelioma treated between 1984 and 1994 by the Cancer and Leukemia Group B. Chest 1998;113:723–731.PubMedGoogle Scholar
  26. 26.
    Furuya Y, Akimoto S, Akakura K, Igarashi T, Murakami S, Shimazaki J, Ito H. Response of prostate-specific antigen after androgen withdrawal and prognosis in men with metastatic prostate cancer. Urol Int 1998;60:28–32.PubMedGoogle Scholar
  27. 27.
    Liaw CC, Wang CH, Huang JS, Kiu MC, Chen JS, Chang HK. Serum lactate dehydrogenase level in patients with nasopharyngeal carcinoma. Acta Oncol 1997;36:159–164.PubMedGoogle Scholar
  28. 28.
    Sirott MN, Bajorin DF, Wong GYC, Tao Y, Chapman PB, Templeton MA, Houghton AN. Prognostic factors in patients with metastatic malignant melanoma. Cancer 1993;72:3091–3098.PubMedGoogle Scholar
  29. 29.
    Eton O, Legha SS, Moon TE, et al. Prognostic factors for survival of patients treated systemically for disseminated melanoma. J Clin Oncol 1998;16:1103–1111.PubMedGoogle Scholar
  30. 30.
    Keilholz U, Scheibenbogen C, Sommer M, Pritsch M, Geuke AM. Prognostic factors for response and survival in patients with metastatic melanoma receiving immunotherapy. Melanoma Res 1996;6:173–178.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 1999

Authors and Affiliations

  • Shefali Agrawal
    • 1
  • Tzy-Jyun Yao
    • 2
  • Daniel G. Coit
    • 3
  1. 1.Department of SurgeryColumbia University College of Physicians and SurgeonsNew York
  2. 2.Departments of BiostatisticsMemorial Sloan-Kettering Cancer CenterNew York
  3. 3.Departments of SurgeryMemorial Sloan-Kettering Cancer CenterNew York

Personalised recommendations