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Ann Thorac Surg 1991;52:204-210
© 1991 The Society of Thoracic Surgeons

Articles

Improved survival after resection of pulmonary metastases from malignant melanoma

Lyall A. Gorenstein, MD, Joe B. Putnam, MD*, Giri Natarajan, MA, Charles A. Balch, MD, Jack A. Roth, MD

Departments of Thoracic Surgery and General Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

* Address reprint requests to Dr Putnam, Department of Thoracic Surgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 109, Houston, TX 77030-4009.

The value of resecting pulmonary metastases from malignant melanoma was retrospectively examined. Between 1981 and 1989, 56 patients (35 men and 21 women with a mean age of 49 years) had 65 pulmonary resections for histologically proven metastatic melanoma after treatment of the primary tumor. In patients undergoing thoracotomy, 50% ( [equation]) had pulmonary metastases as the initial site of recurrence. Twenty-eight patients (50%) had local-regional recurrence before the development of lung metastases. Eight lobectomies, two segmentectomies, and 55 wedge excisions were done. Fifty-four patients ( [equation], 96%) underwent complete resection, and there were no operative deaths. The postthoracotomy actuarial survival was 25% at 5 years (median interval, 18 months). Location of the primary tumor, histology, thickness, Clark level, local-regional lymph node metastases, or type of resection was not associated with improved survival. Patients without regional nodal metastases before thoracotomy had a median survival of 30 months compared with 16 months for all others (p = 0.04). Patients with lung as the site of first recurrence had a median survival of 30 months compared with 17 months for patients with initial local-regional recurrence (p = 0.038, log-rank test). Despite systemic spread, patients with isolated pulmonary metastases from melanoma may benefit from metastasectomy.




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