Anesthesia Management for Palliative Surgery of Massive Hepatic Metastatic Melanoma

We report the perioperative management of a patient with melanoma. Surgical intervention was withheld at multiple institutions because of the presence of metastases; the patient was undergoing experimental immunotherapy and had responded everywhere except in the liver. She underwent hepatic right trisegmentectomy to improve her quality of life and to allow resumption of immunotherapy. Dyspnea because of heart compression, pleural effusion, lung collapse, and pulmonary emboli improved. She died of late complications. This case highlights physiologic and ethical considerations.