Surgery for Advance Melanoma Extends Survival

Source: Newsmax/Health, October 2015

New research suggests that for patients with melanoma that has spread to the abdomen, surgical removal of the tumor can extend survival.

The study was led by Dr. Gary Deutsch, now a surgical oncologist at North Shore-LIJ Health System in Great Neck, N.Y. His team tracked outcomes for 1,600 patients, treated at some point between 1969 and 2014.

According to the study, nearly one in four patients had surgery to remove the mass from their abdomen. Patients who underwent the surgery lived more than twice as long as those who received drug treatment alone — 18 months versus seven months, on average, the researchers reported.

The study was to be presented Thursday at the annual meeting of the American College of Surgeons (ACS) in Chicago.

According to the researchers, in the past, a melanoma that had spread to the liver or another organ in the abdomen was considered incurable. In those cases, surgery was typically deemed to be useless.

As well, in recent years powerful new immune-based drugs have given doctors new pharmaceutical options in fighting advanced melanomas, the researchers noted.

So, with all these changes, would surgical removal of part of a cancerous organ make any difference to patient survival? The new findings suggest that it might, Deutsch said.

“We have been trying to gauge the role of surgical resection for metastatic melanoma since the development of [immune-based drugs]," he said in an ACS news release.

“Today, metastatic melanoma is [also] discovered earlier in a number of patients," Deutsch added, “likely because of better imaging techniques, so surgeons may be able to intervene before it becomes futile."

In the new study, surgery was performed alone, or in combination with drug treatment or radiofrequency ablation, a technique that uses heat to destroy cancer cells.

All of the patients in the study had potentially operable melanoma that had spread to the abdomen. The sole site of abdominal cancer was the liver in nearly 700 patients, the gastrointestinal tract in 336, adrenal glands in 138, spleen in 109, and pancreas in 38. Another 305 patients had multiple cancer sites in the abdomen.

Patients with melanoma that had spread to the gastrointestinal tract and had complete, curative surgery had the longest average survival, the study found, at more than two years.

Deutsch believes that surgery “can really make a difference in the patients with GI tract metastases. The operation can be performed laparoscopically, so it is minimally invasive."
Two cancer surgeons said the findings are welcome news for patients.

“Since stage 4 cancer is not normally treated with surgery, I find it quite amazing that surgical treatment for stage 4 melanoma to the abdomen has such astonishing survival effects, with patients living nearly a year longer compared to patients not surgically treated," said Dr. Todd Coven, a dermatologic surgeon at The Mount Sinai Hospital in New York City.

“Such a study advances hope for patients with stage 4 metastatic melanoma," he said, because the disease otherwise carries “a highly lethal prognosis."

Dr. Stephanie Bernik is chief of surgical oncology at Lenox Hill Hospital, also in New York City. She said that the study may have had what is known as “selection bias," meaning that only those patients with less advanced disease were selected for surgeries in the first place.

“However, even with this bias, there is a suggestion that in carefully selected patients, surgery should be considered," Bernik said.

Deutsch conducted the study while a surgical oncology fellow at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif.

Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.