Laparoscopic management of liver metastases from uveal melanoma Muhammet Akyuz 1 • Pınar Yazici 1 • Cem Dural 1 • Hakan Yigitbas 1 • Alexis Okoh 1 • Emre Bucak 1 • Michael McNamara 2 • Arun Singh 3 • Eren Berber 1 Received: 15 June 2015 / Accepted: 21 August 2015 / Published online: 27 August 2015 Ó Springer Science+Business Media New York 2015 Abstract Background Although uveal melanoma is a rare disease, its metastasis to the liver is associated with a poor survival. The aim of this study is to analyze the survival after sur- gical treatment of uveal melanoma metastases to the liver. Methods Within 15 years, 44 patients with uveal mela- noma metastases to the liver were managed at a single center. Medical records were reviewed to identify patients who underwent surgical treatment of their liver disease. Clinical and oncologic results were compared to those patients who were managed otherwise. T test, Chi-square test, and Kaplan–Meier survival analyses were performed. Results There were 16 patients who underwent surgical treatment (laparoscopic liver resection, n = 2 and laparo- scopic radiofrequency ablation, n = 14), compared to 28 patients who received systemic therapy. The groups were similar regarding demographics and size of primary tumor. The interval between diagnoses of primary tumor and liver metastases was longer for the surgical group (58 vs 22 months, respectively, p = 0.010). Although the domi- nant liver tumor size was similar, the average number of liver tumors was 4 in the surgical group and 10 in the systemic therapy group (p \ 0.0001). The median survival after diagnosis of liver metastases was 35 months in the surgical group and 15 months in the systemic therapy group (p B 0.0001). Five-year survival was zero in the systemic therapy group and 22 % in the surgical group. Conclusions This study shows that surgical treatment of liver metastases in selected patients with uveal melanoma, who have limited liver tumor burden and a long interval to metastases development, may result in long-term survival. Keywords Uveal melanoma Á Liver metastases Á Laparoscopic liver resection Á Laparoscopic radiofrequency ablation Although rare, uveal melanoma is the most common pri- mary intraocular malignant tumor in adults [1]. Liver metastasis develops in 40–50 % of these patients within 10 years after primary diagnosis and is the single site involved in 69–90 % [2–4]. There is no consensus on a standard management of metastatic uveal melanoma. Unfortunately, the median survival is 2–7 months without treatment and depends heavily on the progression of liver disease [5–7]. Therefore, there is merit in considering liver- directed therapies to prolong survival. There are reports in the literature about the use of open liver resection plus/ minus radiofrequency ablation (RFA), percutaneous RFA, embolization therapies (chemoembolization, transarterial chemoembolization, transarterial chemotherapy, and iso- lated hepatic perfusion) and systemic therapy (chemother- apy and immunotherapy) [8–11]. Although these studies are hindered by heterogeneity and small sample size, there is a suggestion that survival is most favorable after liver- directed surgical therapy (resection). However, open liver resection might be associated with a long recovery, mor- bidity, and immunosuppression. Furthermore, only 5–10 % of patients are candidates for resection based on the dis- tribution of disease in the liver [2, 5, 12, 13]. Laparoscopic & Eren Berber berbere@ccf.org 1 Departments of Endocrine and General Surgery, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH 44195, USA 2 Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA 3 The Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA 123 Surg Endosc (2016) 30:2567–2571 DOI 10.1007/s00464-015-4527-9 and Other Interventional Techniques