Surgical resection of pulmonary metastatic melanoma: A review of 83 thoracotomies

Abstract

Although systemic metastases of malignant melanoma are usually multiple and widespread, patients occasionally present with localised, surgically resectable disease, and excision of metastases may be considered. The aims of this study were to examine the outcome for melanoma patients who underwent thoracotomy for the resection of pulmonary metastases and to determine whether any positive prognostic factors could be identified. The records of 9,836 patients of the Sydney Melanoma Unit were reviewed. Of 845 patients who had pulmonary metastases, 83 patients (10%) underwent thoracotomy between January 1958 and February 1991. In 59 of these patients (64%) the lung was the first site of recurrence. Complete macroscopic removal with histologically clear margins was achieved in 90% of patients. In 4 patients, subsequent histological examination revealed pathology other than metastatic melanoma. The median postoperative stay was 9 days, morbidity was low, and there was 1 perioperative death. The median actuarial survival postthoracotomy was 19 months. Twelve patients remain alive with no evidence of melanoma at a median interval of 60 months postthoracotomy. The actuarial survival rate postthoracotomy was 22% at 5 years. If there was no evidence of metastatic disease in any site other than the lung, a favourable outcome was statistically more likely.