Surgery in Stage IV Melanoma Patients: Results from a Single Institution

e19035 Background: There is no consensus regarding the appropriate management of melanoma patients at stage IV and resectable metastases. Methods: We conducted a systematic review and meta-analysis to examine the effect of surgery on overall survival (OS) in patients with resectable metastases. The systematic review was performed by searching MEDLINE, EMBASE, Cochrane and ISI Web of Science. The meta-analysis was performed using time-to-event data from which hazard ratios (HRs) and 95% confidence intervals (CIs) of OS were estimated and summary estimates were obtain through random effects model. Heterogeneity and publication bias were investigated by sensitivity analyses and funnel plot regression Results: Thirty-three retrospective studies evaluating survival from resected and unresected metastases were found from 1978 until 2010. In resected patients median follow-up is 1.5 years and 2-year OS is 27% whereas in unresected the median follow-up is 6 months and 2-year OS is 12%. Meta-analysis was carried out on the seven studies reporting information on visceral metastases and including 1,165 patients. We included also 93 patients at stage IV treated at the European Institute of Oncology, Milan, Italy. Surgery has shown an improvement in survival of patients managed with palliative resection of their visceral metastases: the summary estimate suggests a significant decrease in the risk of mortality of 40% for patients who undergo surgery, with no indication of heterogeneity (HR=0.6 (0.45-0.78); I 2 =0). However we found indication for publication bias (P=0.03) suggesting that small studies published only mainly if they found significant results. Conclusions: Our results suggest the benefit of surgical resection for advanced-stage melanoma. Patients with limited sites and numbers of metastases should be considered for curative resection regardless of the location of the disease.