Surgery for melanoma metastases of the gastrointestinal tract: Indications and results

Aim: To assess survival, morbidity and mortality following therapeutic or palliative resection of gastrointestinal (GI) tract melanoma metastases. Methods: A retrospective case series of 117 patients who underwent surgical resection of GI melanoma metastases between 1981 and 2005 was reviewed. Results: The 117 patients underwent 142 operations for acute and/or sub-acute symptoms or for imminently symptomatic GI metastases detected radiologically. The intent of the surgery was palliative in 53 (37.3%) and therapeutic in 89 (62.7%) operations. The most common symptoms were due to anaemia (40.8%) or bowel obstruction (32.4%). The most frequently performed operation was small bowel resection (76.8%). Preoperative imaging and/or endoscopy were used in 83 cases, with computerised tomography (CT) being most frequent (85.5%). CT had a sensitivity of 68.8% when used alone to detect the presence of GI metastases in the study population. The mortality rate following GI resection was 1.4%, and 2.5% of patients had post-operative complications. Overall 5-year survival was 27%. On multivariate analysis, the presence of residual intraabdominal disease and the presence of non-GI metastases at the time of surgery or after surgery were the most significant prognostic indicators of survival. Conclusions: Resection of GI melanoma metastases is safe, relieves symptoms and can achieve prolonged remission. In patients with limited disease, an aggressive surgical approach to symptomatic or imminently symptomatic GI melanoma metastases is warranted. (C) 2008 Elsevier Ltd. All rights reserved.