Perioperative complication and surgical outcome in patients with spine metastases: Retrospective 200-case series in a single institute☆
Introduction
Geriatric populations are at increased risk for cancer, and as their population increases worldwide, so does the incidence of spinal metastasis [1]. Thus, spine specialists are encountering patients with spinal metastasis more often. Advanced multimodular treatments have improved the life expectancies of these patients [1], [2]. Many authors have reported the results of various surgical techniques on progressed spinal metastases [3], [4], [5]. The high complication rates of surgical techniques must be weighed against the benefits, otherwise patients can undergo unnecessarily massive procedures, shorten the patients’ lifespan, and lower their quality of life [6]. Therefore, surgical outcomes including postoperative survival, perioperative complications and mortality should be analyzed and compared to the various surgical techniques, from the less aggressive palliative method to an en-bloc excision, which is the most aggressive. With this vital information, spinal surgeons can choose the optimal surgical techniques in treating patients with spinal metastasis by weighing the risks and benefits. Accordingly the purpose of this particular study is to compare the surgical outcomes; i.e., postoperative survival, perioperative complications and mortality among the available surgical options, such as en bloc, debulking, and palliative surgeries in patients with spinal metastasis.
Section snippets
Materials and methods
From 2005 to 2010, 200 patients who underwent surgical treatment for spinal metastases were listed based on the World Health Organization (WHO) International Statistical Classification of Diseases and Related Health Problems, 10th Revision, 2007, known as ICD-10. Secondary malignant neoplasm of bone and bone marrow code (C79.5) were searched by an electronic medical record search program. The medical records for all enrolled patients were reviewed thoroughly to confirm spinal metastasis and
Results
This study enrolled 200 patients comprising 118 males and 82 females. The major primary cancers were lung cancer in 42 cases (21.0%), liver cancer in 27 (13.5%), colorectal cancer in 27 (13.5%), renal cancer in 22 (11.0%), breast cancer in 15 (7.5%), thyroid cancer in 11 (5.5%), stomach cancer in 7 (3.5%), prostate cancer in 6 (3.0%), and multiple myeloma in 6 (3.0%) (Table 1). The mean age was 59.7 ± 12.4 (range 21–87). There were no differences in demographics and distribution of primary cancer
Discussion
As adjuvant therapies have improved, patients with metastases are living longer after diagnosis [10], [11]. In previous decades, patients with spinal metastases were considered to be in the terminal stage of their disease and thus required only palliative surgical treatments [12]. New radiologic imaging and surgical techniques, however, have made it possible to detect the earliest spinal metastatic lesions and properly treat spinal metastases. Moreover, recent technique such as tomotherapy
Conclusion
Postoperative complications were most common in the debulking group compared to those in en bloc and palliative groups, despite the fact that there were no differences in the improvement of neurologic deficits after surgery. Therefore, selecting the proper surgery based on the patients’ symptoms and neurologic status, as well as paying closer attention to reducing perioperative complications during surgery, can result in better control of spinal metastasis and possibly a better quality of life
Source of funding
None.
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All the experimental protocols involving human subjects were approved by the Institutional Review Board of each participating institution.
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Present address: Department of Orthopaedic Surgery, International St. Mary’s Hospital, Shimgok-dong, Seo-ku, In-Cheon, 404-834, Republic of Korea.