Liver Resection Improves Metastatic Melanoma Survival

Surgical resection markedly improves survival among metastatic melanoma patients whose disease is isolated to a few areas in the liver, according to a new study.

Researchers at John Wayne Cancer Institute (JWCI; Santa Monica, CA, USA) conducted a retrospective study involving 1,078 patients with melanoma liver metastases treated at JWCI since 1991, 58 (5.4%) of whom received surgical therapy that included resection with or without radiofrequency or microwave ablation. The researchers calculated overall and disease-specific survival rates from hepatic metastasis diagnosis. Potential prognostic factors included primary tumor type, depth, medical treatment response, location, and surgical approach.

The results showed that the median and 5-year overall survival were 8 months and 6.6%, respectively, for 1,016 nonsurgical patients, compared to 24.8 months and 30%, respectively, for surgical patients. The median overall survival was similar among patients undergoing ablation (with or without resection) relative to those undergoing surgery alone. Upon analysis, therapeutic stabilization of melanoma before surgery and completing surgery predicted the overall survival rate. The study was published in the July 2014 issue of the Journal of the American College of Surgeons.

“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,” concluded lead author Mark Faries, MD, FACS, director of the JWCI melanoma research program, and colleagues. “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.”

Melanoma, an aggressive form of skin cancer, is often considered fatal once it converts to metastatic melanoma (also known as stage IV melanoma). Once the melanoma cells (cutaneous, mucosal, or ocular) have spread through the lymphatic system to distant sites in the body and/or to organs such as the liver, lungs, bones, and brain, it is usually not amenable to surgical treatment. However, advances in surgical techniques along with new systemic therapies have made existing therapies more effective and opened the door to new therapeutic approaches.

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John Wayne Cancer Institute