Abstract
Objectives
To compare surgical outcomes such as the ambulatory period and survival according to different surgical excision tactics for metastatic spine tumors (MSTs).
Summary of Literature Review
Surgical outcomes, such as pain relief and survival, in patients with MSTs have been reported in several studies, but the effects of differences in surgical extent on the ambulatory period have rarely been reported.
Materials and Methods
Ninety-six patients with MSTs who underwent palliative (n=60) or extensive wide excision (n=36) were included. Palliative excision was defined as partial removal of the tumor as an intralesional piecemeal procedure for decompression. Extensive wide excision was defined as a surgical attempt to remove the whole tumor at the index level as completely as possible. The primary outcome was the ambulatory period following surgery. Other demographic and radiographic parameters were analyzed to identify the risk factors for loss of ambulatory ability and survival. Perioperative complications were also assessed.
Results
The mean postoperative ambulatory period was longer in the extensive wide excision group (average 14.8 months) than in the palliative excision group (average 11.7 months) (p=0.021). The survival rates were not significantly different between the two surgical excision groups (p=0.680). However, postoperative ambulatory status and major complications within 30 days postoperatively were significant prognostic factors for survival (p=0.003 and p=0.032, respectively).
Conclusions
The extent of surgical excision affected the ambulatory period, and the complication rates were similar, regardless of surgical excision tactics. A proper surgical strategy to achieve postoperative ambulatory ability and to reduce perioperative complications would have a favorable effect on survival.
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Table 1.
Total (n=96) | P group (n=60) | W group (n=36) | p | |
---|---|---|---|---|
Age (range) | 57.1±12.8(21-86) | 56.2±13.4(21-86) | 58.6±11.6(23-79) | NS∗ |
Male (n, [%]) | 62(64.6) | 46(76.7) | 16(44.4) | 0.001† |
Surgical level | ||||
Cervical | 10 | 4 | 6 | NS‡ |
Thoracic | 56 | 36 | 20 | |
Lumbosacral | 30 | 20 | 10 | |
Tumor diagnosis to surgery, median (month) | 11.0(0-170) | 11.0(0-154) | 12.0(1-170) | NS¶ |
Symptom to surgery, median (day) | 24.5(0-330) | 21(1-240) | 36.5(0-330) | NS§ |
Metastasis (n) | ||||
None | 9 | 6 | 3 | |
Non-spinal bone | 19 | 15 | 4 | NS‡ |
Visceral | 37 | 21 | 16 | |
Both | 31 | 18 | 13 | |
No. of metastatic spine segments (n) | ||||
1-2 | 32 | 17 | 15 | NS† |
≥3 | 64 | 43 | 21 | |
Preop. ECOG-PS (n) | ||||
1 | 39 | 22 | 17 | |
2 | 25 | 11 | 14 | NS‡ |
3 | 25 | 20 | 5 | |
4 | 7 | 7 | 0 | |
Ambulatory (n, [%]) | 73(76.0) | 41(68.3%) | 32(88.9%) | 0.022† |
ASA physical status classification (n) | ||||
1-2 | 75 | 50 | 25 | NS† |
3 | 21 | 10 | 11 | |
Preop. serum albumin (g/dL) | 3.4±0.5 | 3.4±0.5 | 3.6±0.6 | 0.010∗ |
≥3.0 (n) <3.0 (n) |
50 10 |
30 6 |
NS† | |
Preop. embolization (n) | 45 | 19 | 26 | <0.001 |
Table 2.
Total (n=96) | P group (n=60) | W group (n=36) | p∗ | |
---|---|---|---|---|
0 | 7(7.3%) | 4(6.7%) | 3(8.3%) | |
1 | 19(19.8%) | 11(18.3%) | 8(22.2%) | NS |
2 | 19(19.8%) | 10(16.7%) | 9(25%) | |
3 | 51 (53.1%) | 35(58.3%) | 16(44.5%) |
Table 3.
P group (n=60) | W group (n=36) | p∗ | |
---|---|---|---|
Postop. RT | 33(55%) | 27(75%) | NS |
Preop. CT | 32(53.3%) | 19(52.8%) | |
PD | 23 | 15 | NS |
SD or PR | 9 | 4 | |
Postop. CT | 27(45%) | 21(58.3%) | NS |
Table 4.
Loss of ambulatory status during follow-up | Survival∗ | |||||
---|---|---|---|---|---|---|
P for univariate analysis | P for multivariate analysis | HR (95% CI) | P for univariate analysis | P for multivariate analysis | HR (95% CI) | |
Sex | 0.288 | 0.886 | ||||
Age (≥60 vs. <60 y) | 0.128 | 0.589 | 0.740 | |||
Location of metastasis | 0.407 | 0.911 | ||||
Wide excision vs. Palliative excision | 0.030 | 0.034 | 0.418(0.187-0.935) | 0.689 | ||
Adjuvant RT (Yes vs. No) | 0.441 | 0.007 | 0.191 | |||
Preop. CT (No vs. PD or SD/PR) | 0.056 | 0.170 | 0.362 | |||
Postop. CT (Yes vs. No) | 0.333 | 0.486 | ||||
Preop. ECOG-PS (1-2 vs. 3-4) | 0.583 | 0.002 | 0.499 | |||
Preop. ambulatory (Yes vs. No) | 0.264 | <0.001 | 0.951 | |||
Postop.(within 30d) ambulatory (Yes vs. No) | 0.602 | <0.001 | 0.003 2 | 2.675(1.408-5.083) | ||
ASA (1-2 vs. 3-4) | 0.358 | 0.578 | ||||
ESCC scale (0-1 vs. 2-3) | 0.470 | 0.268 | ||||
Number of metastatic spine (1-2 vs. ≥3) | 0.307 | 0.795 | ||||
Extraspinal bone metastasis (Yes vs. No) | 0.343 | 0.480 | ||||
Visceral metastasis (Yes vs. No) | 0.280 | 0.233 | ||||
Preop. serum albumin (<3.0 vs. ≥3.0 g/dL) | 0.072 | 0.675 | 0.857 | |||
Intraop. bleeding (≥2000 vs. <2000 cc) | 0.377 | 0.908 | ||||
Perioperative major complication (Yes vs. No) | 0.120 | 0.129 | 0.003 | 0.032 | 0.491 (0.256-0.940) |
Preop: preoperative, RT: radiotherapy, CT: chemotherapy, PD: progressive disease, SD: stable disease, PR: partial remission, ECOG-PS: the Eastern Co-operative Oncology Group-Performance Status, ASA: American Society of Anesthesiologist, ESCC: epidural cord compression, HR:hazard ratio, CI: confi-dence interval, N/A: not applicable.
Table 5.
Total (n=96) | P group (n=60) | W group (n=36) | P∗ | |
---|---|---|---|---|
Total | 23 | 15 | 8 | |
Pneumonia | 9 | 6 | 3 | |
Wound problems | 7 | 4 | 3 | |
Thromboembolism | 3 | 3 | 0 | NS |
GI bleeding | 2 | 1 | 1 | |
Sepsis | 3 | 1 | 2 | |
CVA | 1 | 1 | 0 | |
Death | 10 | 7 | 3 | NS |