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Factors Affecting Survival in Patients Undergoing Palliative Spine Surgery for Metastatic Lung and Hepatocellular Cancer: Dose the Type of Surgery Influence the Surgical Results for Metastatic Spine Disease?

Ha KY, Kim YH, Ahn JH, Park HY - Clin Orthop Surg (2015)

Bottom Line: Pre- and postoperative (3 months) pain (visual analogue scale, VAS), performance status (Karnofsky performance score), neurologic status (American Spinal Injury Association [ASIA] grade), and spinal instability neoplastic score (SINS) were compared.In an analysis according to operation type, there was no significant difference in patient demographics.Preoperative Karnofsky score and improvement of performance status had a significant impact on the survival rate following surgical treatment for these metastatic spine lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background: Surgical treatment for metastatic spine disease has been becoming more prominent with the help of technological advances and a few favorable reports on the surgery. In cases of this peculiar condition, it is necessary to establish the role of surgery and analyze the factors affecting survival.

Methods: From January 2011 to April 2015, 119 patients were surgically treated for metastatic spine lesions. To reduce the bias along the heterogeneous cancers, the primary cancer was confined to either the lung (n = 25) or the liver (n = 18). Forty-three patients (male, 32; female, 11; mean age, 57.5 years) who had undergone palliative surgery were enrolled in this study. Posterior decompression and fusion was performed in 30 patients (P group), and anteroposterior (AP) reconstruction was performed in 13 patients (AP group) for palliative surgery. Pre- and postoperative (3 months) pain (visual analogue scale, VAS), performance status (Karnofsky performance score), neurologic status (American Spinal Injury Association [ASIA] grade), and spinal instability neoplastic score (SINS) were compared. The survival period and related hazard factors were also assessed by Kaplan-Meier and Cox regression analysis.

Results: Most patients experienced improvements in pain and performance status (12.3% ± 17.2%) at 3 months postoperatively. In terms of neurologic recovery, 9 patients (20.9%) graded ASIA D experienced neurological improvement to ASIA E while the remainder was status quo. In an analysis according to operation type, there was no significant difference in patient demographics. At 12 months postoperatively, cumulative survival rates were 31.5% and 38.7% for the P group and the AP group, respectively (p > 0.05). Survival was not affected by the pre- and postoperative pain scale, Tokuhashi score, neurologic status, SINS, or operation type. Preoperative Karnofsky performance score (hazard ratio, 0.93; 95% confidence interval [CI], 0.89 to 0.96) and improvement of performance status after surgery (hazard ratio, 0.95; 95% CI, 0.92 to 0.97) significantly affected survival after operation.

Conclusions: There was no significant difference in surgical outcomes and survival rates between posterior and AP surgery for metastatic lesions resulting from lung and hepatocellular cancer. Preoperative Karnofsky score and improvement of performance status had a significant impact on the survival rate following surgical treatment for these metastatic spine lesions.

No MeSH data available.


Related in: MedlinePlus

A 73-year-old man was diagnosed with non-small cell lung cancer. He presented with intractable back pain and progressive lower extremity weakness (Karnofsky performance status 70% and Frankel E). (A) Initial evaluation revealed impending spinal cord injury at T10 (spinal instability neoplastic score 7). (B) Posterior decompression and fusion was done. (C) Postoperative radiotherapy was also applied for this local lesion. At 9 months postoperatively, he still lives actively by himself (Karnofsky performance status 80%).
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Figure 2: A 73-year-old man was diagnosed with non-small cell lung cancer. He presented with intractable back pain and progressive lower extremity weakness (Karnofsky performance status 70% and Frankel E). (A) Initial evaluation revealed impending spinal cord injury at T10 (spinal instability neoplastic score 7). (B) Posterior decompression and fusion was done. (C) Postoperative radiotherapy was also applied for this local lesion. At 9 months postoperatively, he still lives actively by himself (Karnofsky performance status 80%).

Mentions: The decision for surgical intervention and/or RT was made by a multi-disciplinary team, which included an oncologist, a radio-oncologist, and a spine surgeon, with options discussed with patients and their family. Decompression, through debulking or excision, was performed for each patient and augmented with either posterior only or anteroposterior (AP) reconstruction. The decision regarding instrumented stabilization was based on a combined assessment of patient symptoms, static and dynamic imaging, the surgeon's opinion, and inherent or potential instability brought about by the disease process, as well as patient co-morbidities and overall health. Posterior only surgery was kept to a minimum, providing indirect decompression to any anterior mass and mechanical stability (Fig. 1); while AP surgery involved a more extensive excision or debulking of the metastatic lesions (Fig. 2). Postoperative RT for the operated lesion was performed in 34 of 43 patients (79.1%) and was started at 3 weeks after surgery to allow for wound healing.


Factors Affecting Survival in Patients Undergoing Palliative Spine Surgery for Metastatic Lung and Hepatocellular Cancer: Dose the Type of Surgery Influence the Surgical Results for Metastatic Spine Disease?

Ha KY, Kim YH, Ahn JH, Park HY - Clin Orthop Surg (2015)

A 73-year-old man was diagnosed with non-small cell lung cancer. He presented with intractable back pain and progressive lower extremity weakness (Karnofsky performance status 70% and Frankel E). (A) Initial evaluation revealed impending spinal cord injury at T10 (spinal instability neoplastic score 7). (B) Posterior decompression and fusion was done. (C) Postoperative radiotherapy was also applied for this local lesion. At 9 months postoperatively, he still lives actively by himself (Karnofsky performance status 80%).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553283&req=5

Figure 2: A 73-year-old man was diagnosed with non-small cell lung cancer. He presented with intractable back pain and progressive lower extremity weakness (Karnofsky performance status 70% and Frankel E). (A) Initial evaluation revealed impending spinal cord injury at T10 (spinal instability neoplastic score 7). (B) Posterior decompression and fusion was done. (C) Postoperative radiotherapy was also applied for this local lesion. At 9 months postoperatively, he still lives actively by himself (Karnofsky performance status 80%).
Mentions: The decision for surgical intervention and/or RT was made by a multi-disciplinary team, which included an oncologist, a radio-oncologist, and a spine surgeon, with options discussed with patients and their family. Decompression, through debulking or excision, was performed for each patient and augmented with either posterior only or anteroposterior (AP) reconstruction. The decision regarding instrumented stabilization was based on a combined assessment of patient symptoms, static and dynamic imaging, the surgeon's opinion, and inherent or potential instability brought about by the disease process, as well as patient co-morbidities and overall health. Posterior only surgery was kept to a minimum, providing indirect decompression to any anterior mass and mechanical stability (Fig. 1); while AP surgery involved a more extensive excision or debulking of the metastatic lesions (Fig. 2). Postoperative RT for the operated lesion was performed in 34 of 43 patients (79.1%) and was started at 3 weeks after surgery to allow for wound healing.

Bottom Line: Pre- and postoperative (3 months) pain (visual analogue scale, VAS), performance status (Karnofsky performance score), neurologic status (American Spinal Injury Association [ASIA] grade), and spinal instability neoplastic score (SINS) were compared.In an analysis according to operation type, there was no significant difference in patient demographics.Preoperative Karnofsky score and improvement of performance status had a significant impact on the survival rate following surgical treatment for these metastatic spine lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background: Surgical treatment for metastatic spine disease has been becoming more prominent with the help of technological advances and a few favorable reports on the surgery. In cases of this peculiar condition, it is necessary to establish the role of surgery and analyze the factors affecting survival.

Methods: From January 2011 to April 2015, 119 patients were surgically treated for metastatic spine lesions. To reduce the bias along the heterogeneous cancers, the primary cancer was confined to either the lung (n = 25) or the liver (n = 18). Forty-three patients (male, 32; female, 11; mean age, 57.5 years) who had undergone palliative surgery were enrolled in this study. Posterior decompression and fusion was performed in 30 patients (P group), and anteroposterior (AP) reconstruction was performed in 13 patients (AP group) for palliative surgery. Pre- and postoperative (3 months) pain (visual analogue scale, VAS), performance status (Karnofsky performance score), neurologic status (American Spinal Injury Association [ASIA] grade), and spinal instability neoplastic score (SINS) were compared. The survival period and related hazard factors were also assessed by Kaplan-Meier and Cox regression analysis.

Results: Most patients experienced improvements in pain and performance status (12.3% ± 17.2%) at 3 months postoperatively. In terms of neurologic recovery, 9 patients (20.9%) graded ASIA D experienced neurological improvement to ASIA E while the remainder was status quo. In an analysis according to operation type, there was no significant difference in patient demographics. At 12 months postoperatively, cumulative survival rates were 31.5% and 38.7% for the P group and the AP group, respectively (p > 0.05). Survival was not affected by the pre- and postoperative pain scale, Tokuhashi score, neurologic status, SINS, or operation type. Preoperative Karnofsky performance score (hazard ratio, 0.93; 95% confidence interval [CI], 0.89 to 0.96) and improvement of performance status after surgery (hazard ratio, 0.95; 95% CI, 0.92 to 0.97) significantly affected survival after operation.

Conclusions: There was no significant difference in surgical outcomes and survival rates between posterior and AP surgery for metastatic lesions resulting from lung and hepatocellular cancer. Preoperative Karnofsky score and improvement of performance status had a significant impact on the survival rate following surgical treatment for these metastatic spine lesions.

No MeSH data available.


Related in: MedlinePlus