Survival and morbidity following metastasectomy for stage IV melanoma in the era of systemic therapy: A multicenter retrospective cohort study

<h2>Abstract</h2><h3>Background</h3> Modern systemic therapies for stage IV melanoma often result in remarkable and durable responses. Consequently, the indications for surgical resection in stage IV melanoma patients are evolving and remain debated. This study examines the survival and morbidity following metastasectomy for stage IV melanoma in the era of systemic therapy. <h3>Methods</h3> A multicenter, retrospective cohort study was conducted at the University Medical Center Groningen and Radboud University Medical Center Nijmegen. Adult patients with stage IV (AJCC 8th) melanoma who received systemic therapy and had metastasectomy between 2010 and 2020 were included. Outcomes were overall survival (OS), progression-free survival (PFS), and morbidity following metastasectomy. <h3>Results</h3> Forty-four patients were included (median age 57 years; 54.5 % females). Twenty-five (56.8 %) patients underwent metastasectomy to achieve no evidence of disease and 19 (43.2 %) patients for symptomatic metastases. The most common procedures were small bowel segmental resections (38.6 %) and skin/soft tissue excisions (19.3 %). Postoperative complications occurred in seven (15.9 %) patients and were mostly treated conservatively. During a median follow-up of 139 months, mean OS was 92 months, and median PFS was 23 months. Patients who experienced at a least partial response to systemic treatment before metastasectomy (HR 0.24, <i>p</i> = 0.029) and had treatment from 2016 (HR 0.21, <i>p</i> = 0.004) had prolonged OS. <h3>Conclusions</h3> Metastasectomy in selected stage IV melanoma patients was associated with favorable OS, particularly in patients who had at least a partial response to systemic treatment prior to metastasectomy and had treatment from 2016. Postoperative morbidity was acceptable. <h3>Synopsis</h3> This study evaluates the survival and morbidity following metastasectomy for stage IV melanoma in the era of systemic therapy, revealing favorable outcomes, particularly in patients with at least a partial response to systemic treatment prior to surgery and who had treatment after 2016.