Systematic review and meta-analysis of liver resection for metastatic melanoma

Background The multidisciplinary management of metastatic melanoma now occasionally includes major hepatic resection. The objective of this work was to conduct a systematic review of the literature on liver resection for metastatic melanoma. Methods MEDLINE, Embase, the Cochrane Library and Scopus w...

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Bibliographic Details
Published in:British journal of surgery 2013-08, Vol.100 (9), p.1138-1147
Main Authors: Aubin, J.-M., Rekman, J., Vandenbroucke-Menu, F., Lapointe, R., Fairfull-Smith, R. J., Mimeault, R., Balaa, F. K., Martel, G.
Format: Article
Language:English
Subjects:
Adult
Aged
Confidence intervals
Female
Hepatectomy - methods
Humans
Liver
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Male
Melanoma
Melanoma - secondary
Melanoma - surgery
Middle Aged
Skin Neoplasms
Treatment Outcome
Tumors
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Summary:Background The multidisciplinary management of metastatic melanoma now occasionally includes major hepatic resection. The objective of this work was to conduct a systematic review of the literature on liver resection for metastatic melanoma. Methods MEDLINE, Embase, the Cochrane Library and Scopus were searched (1990 to December 2012). Studies with at least ten patients undergoing liver resection for metastatic melanoma were included. Data on the outcomes of overall survival (OS) and/or disease‐free survival (DFS) were ed and synthesized. Hazard ratios (HRs) were derived from survival curves and subjected to meta‐analysis using random‐effects models. Results Twenty‐two studies involving 579 patients (13 per cent weighted resection rate) who underwent liver resection were included. Study quality was poor to moderate. Median follow‐up ranged from 9 to 59 months. Median DFS ranged from 8 to 23 months, and median OS ranged from 14 to 41 months (R0, 22–66 months, R2, 10–16 months; R0 versus R1/R2: HR 0.52, 95 per cent confidence interval (c.i.) 0.37 to 0.73). The OS rate was 56–100 per cent at 1 year, 34–53 per cent at 3 years and 11–36 per cent at 5 years. Median OS with non‐operative management ranged from 4 to 12 months. Comparison of OS with resection and non‐operative management favoured resection (HR 0.32, 95 per cent c.i. 0.22 to 0.46). Conclusion Radical resection of liver metastases from melanoma appears to improve overall survival compared with non‐operative management or incomplete resection, but this observation requires future confirmation as selection bias may have confounded the results. Potential role in selected cases
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.9189