The increasing role of abdominal metastesectomy for malignant melanoma in the era of modern therapeutics |
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| Affiliation: | 1. Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel;2. The Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel;1. Department of Chemotherapy, Kazakh Institute of Oncology and Radiology, Almaty, Republic of Kazakhstan;2. Department of Oncology with the Course of Hematology, Kazakh Medical University of Continuing Education, Almaty, Republic of Kazakhstan;3. Department of Administration, Kazakh Institute of Oncology and Radiology, Almaty, Republic of Kazakhstan;4. Consultative and Diagnostic Center, Kazakh Institute of Oncology and Radiology, Almaty, Republic of Kazakhstan;5. Operating Theatre, Kazakh Institute of Oncology and Radiology, Almaty, Republic of Kazakhstan;6. Department of Oncology, S.D. Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan;1. Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan;2. Department of Genomic Medicine, Mie University, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan;1. Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, Kerpener Strasse 62 50937, Cologne, Germany;2. Clinic for Pneumology and Allergology, Hospital Bethanien, Aufderhöher Strasse, 169 42699, Solingen, Germany;1. Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany;2. Faculty of Medicine, Goethe University, Frankfurt am Main, Germany;3. Department of Statistics, Chulalongkorn University Business School, Bangkok, Thailand;4. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand;5. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand;6. Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand;7. Department of Plastic, Reconstructive, Esthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France |
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| Abstract: | BackgroundMetastatic spread of malignant melanoma to the abdomen presents a therapeutic challenge. Targeted and Immune-therapies dramatically improve patients’ survival, yet some patients may still benefit from surgical intervention. This study investigates the outcomes of surgical treatment of abdominal metastatic melanoma in the era of modern therapy.MethodsThis is a retrospective study of all patients who underwent surgical resection for abdominal metastatic melanoma between the years 2009–2021 (n = 80). We examined the clinical, operative, perioperative, and oncological outcomes of these patients.ResultsThe cohort included a therapeutic group (T, n = 43) and palliative group (P, n = 37). The rate of overall post-operative complications was lower in the T group (n = 3, 9.3%) compared to the P group (n = 10, 27.1%) (p = 0.04), but no difference in major complications rate (p = 0.41). The median follow-up was 13.4 months (range, 0.5–107), with an estimated 2- and 5-years survival of 66.5% and 45.3% respectively. The estimated 2- and 5-years survival of the T group was 76.61% and 69.65%, and 49.01% and 28.01% in the P group (p = 0.005). Univariate analysis identified Therapeutic resection (HR 3.2, p = 0.008), isolated lesions (HR 1.47, p = 0.033) and major complication score (HR 1.8, p=<0.001) to be correlated with survival. On multivariate analysis, Therapeutic resection (HR 2.53, p = 0.042) and major complication score (HR 1.62, p = 0.004) remained significant independent factors correlated with survival. In patients who progressed on treatment, and their progression was treated with surgical resection 46.1% where able to be maintained on the same preoperative treatment strategy.ConclusionWe have demonstrated that abdominal metastesectomy is a safe and oncologically efficacious therapy in selected patients. Especially in the era of modern therapeutics, patients with isolated disease site, limited resectable progression on therapy, or patients with symptomatic metastases should be considered for surgical resection. |
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| Keywords: | Melanoma Metastatic Surgery |
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