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Hepatectomy extends survival rate of patients with uveal melanoma, liver metastasis
Br J Ophthalmol. 2009;93(8):1042-1046.
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Uveal melanoma patients with liver metastases who underwent lesion resectioning surgery survived more than three times longer than patients who did not have surgery, according to a study.
"It is possible to extend significantly the life expectancy of uveal melanoma patients who develop isolated hepatic metastases by complete resection of the lesions," the study authors said.
The retrospective case series included 558 uveal melanoma patients treated at one center in Israel between 1988 and 2007. Primary outcome measures were survival rates after hepatectomy.
Study data showed that 74 patients developed liver metastases at a median 35 months after the primary diagnosis of uveal melanoma. Thirty-five patients underwent resectioning surgery. Operated patients and non-operated patients had similar clinical characteristics, the authors said.
Operated patients survived 3.7 times longer after detection of metastases than non-operated patients. Patients who had one to five metastatic nodules survived 3.1 times longer after hepatectomy than those with six or more nodules.
Uveal melanoma is a potentially deadly disease. The management of metastatic disease is difficult. If the disease is extensive in multiple organs, then chemotherapy can be attempted but is usually only temporarily of help. If the metastases are in the liver, then chemoembolization with moderate prolongation of life can be provided. In this article by Frenkel et al, the authors indicate that surgical resection of metastatic foci in the liver is beneficial as opposed to other methods. They found nearly four times survival improvement in patients who underwent surgery compared to the non-operated patients. Patients with fewer metastatic foci in the liver (less than or equal to five) showed three times longer survival than those with more foci. In our practice at Wills Eye Institute, we have had similar experience and we reserve surgical resection for patients who have few liver metastases and no systemic metastasis. We have had several patients survive for 5 years and a few for even up to 10 years post-resection. We agree with the authors that this approach can be beneficial to the patient.
– Carol L. Shields, MD
Co-Director,
Oncology Service, Wills Eye Institute, Philadelphia