Intention-to-Treat Analysis of Hepatic Resection for Liver Metastases from Uveal Melanoma: A Single-Center Experience

Background: Uveal melanoma metastasizes to the liver in almost 50% of patients. The prognosis of liver metastases from uveal melanoma (LMUM) is dismal; however, results from retrospective monocentric series suggest that surgery may improve survival in selected patients. We report our results of surgical explorations and hepatic resections for LMUM. Methods: We retrospectively analyzed our prospectively collected institutional database of hepatic resections for LMUM between 2013 and 2023. Results: In total, 22 patients underwent surgical exploration (median age 61 years, 41% female patients): 15 (68%) underwent curative-intent surgery (surgery group) while 7 (32%) had their resection aborted owing to intraoperatively unresectable disease (staging alone group). Patients in the surgery group had a longer interval between diagnosis of the primary tumor and LMUM (> 36 months in 64%, versus 29% in the staging alone group, p = 0.18). Preoperative imaging and intraoperative staging were concordant in ten (45%) cases, while five (23%) had more lesions, six (27%) had miliary disease, and one (4.5%) had peritoneal carcinomatosis. Minor postoperative complications occurred in 3 (14%) patients. All patients in the staging alone group underwent subsequent systemic or locoregional treatment. Median overall survival was 27 (15–47) months after surgery and 15 (8–21) months after staging alone. Recurrence after surgery occurred in 7/15 patients, with a median disease-free survival of 28 (4–38) months. Conclusions: More than 30% of patients with LMUM with preoperatively resectable disease are unresectable at explorative surgery. Acceptable recurrence rates and good survival outcomes are observed when radical surgery can be performed.