Hepatic resection for metastatic melanoma: The role of surgical treatment

Abstract

determined and related to the presence or absence of cholestasis and biliary drainage of the embolized lobe. Results: When PE was performed in patients without biliary drainage left lobe increased to 48-52% of total liver volume to 8e14 days after PE that was more than 100% of previous left lobe volume. In patients with biliary drained of embolised liver, left lobe increased to 20e48% of total liver volume to 30-35 days after embolization.Conclusions: Preliminary results of prospective study of PE in patients with Klatskin tumor showed that PE without biliary drainage of embolized liver cause significant(more than 100%) hypertrophy of remnat liver in shot period of time(8e14 days). Whenever possible, biliary drainage should not be performed in the lobe undergoing hepatectomy. Aims: Melanoma liver metastasis has a very poor prognosis, with median survival shorter than 6 months when unresected. Liver resection for colorectal liver metastases (CLM) has become a gold standard, but value of surgery in patients with melanoma liver metastasis still remains unclear. The aim of this study was to assess survival and prognostic factors of stage-IV melanoma patients who underwent surgical resection of hepatic metastases. Methods: Clinical data of 38 patients with cutaneous (n = 14; 36.8%) and ocular (n = 24; 63.2%) melanoma metastasis limited to the liver who underwent hepatic resection in between 1999-2014 was reviewed retrospectively. The long-term survival was estimated with the Kaplan-Meier method and compared with the survival after hepatic resection of CLM evaluated in the same department (n = 1,029). Potential prognostic factors including resection margin and interval between the diagnosis of the primary and liver metastasis were evaluated. Results: Overall survival rates after liver resection at 1,3,5 years were 64.9%, 36.6%, 25.3% for patients with metastatic melanoma and 88.0%, 61.5%, 47.6% for patients with CLM, respectively (p < 0.05). Improved post-resection survival was observed in patients with microscopically clear resection margins. The median and 1,3,5 years survival of patient after R0 resection (n = 19, 50%) was 49.5 months (ranges 7.01e146.1) and 88.9%, 57.9%, 43.5% compared to the group of patients received R2 resection (n = 19, 50%) 13.5 months (ranges 0.7e62.6) and 40.5%, 13.9%, 6.9%, respectively (p = 0.0001). The second independent positive prognostic factor was time between primary tumour treatment and hepatic secondaries resection longer than 48 months (p = 0.024). Conclusions: Obtained clinical efficacy of liver resection in patients with metastatic melanoma is not satisfying when compared to metastatic colorectal cancer. Due to the limited treatment options of metastatic liver melanoma, the aggressive surgical approach should be considered when complete resection is feasible. Patients with long interval between primary and liver metastasis melanoma may also benefit from liver resection. Aims:99mTc-mebrofenin-hepatobiliary-scintigraphy (HBS) is a quantitative method enabling functional assessment...