Place Of Surgery In The Treatment Of Liver Metastases Of Uveal Melanoma

Background: Uveal melanoma is characterized by a high prevalence of hepatic metastasis and poor prognosis. The aim of this study was a review of the evolving surgical management of this challenging condition at a single institution over 16 years. In addition, predictive indicators of survival were evaluated in order to determine the optimal candidates for surgical intervention.Patients and methods: The median interval between ocular tumor diagnosis and liver surgery was 68 months. All patients treated for uveal melanoma at the Institut Curie underwent detailed, retrospective review of their clinical records and surgical intervention. The data was evaluated with both uni-and multivariate statistical analysis for prognostic indicators.Results: Liver Surgery was either microscopically complete (RO) n=76, microscopically incomplete (R1) n=22 or macroscopically incomplete (R2) in the remaining 157 patients. The median post operative overall survival was 14 months, but increased to 27 months when RO resection was possible. With multivariate analysis, four variables were found to independently correlate with prolonged survival: interval from primary to metastases > 24 months, type of resection RO, number of metastases resected (<= 4) and absence of miliary disease.Conclusions: Aggressive surgical resection, where possible, is able to almost double the survival. It appears at present the optimal way of improving the prognosis in metastatic uveal melanoma and further progress with medical treatments will be required to improve the survival.