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Perioperative complication and surgical outcome in patients with spine metastases: Retrospective 200-case series in a single institute

Authors
 Byung Ho Lee  ;  Jin-Oh Par  ;  Hak-Sun Ki  ;  Young-Chang Par  ;  Hwan-Mo Le  ;  Seong-Hwan Moon 
Citation
 CLINICAL NEUROLOGY AND NEUROSURGERY, Vol.122 : 80-86, 2014 
Journal Title
 CLINICAL NEUROLOGY AND NEUROSURGERY 
ISSN
 0303-8467 
Issue Date
2014
MeSH
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Intraoperative Complications/epidemiology* ; Male ; Middle Aged ; Orthopedic Procedures/adverse effects ; Orthopedic Procedures/methods* ; Postoperative Complications/epidemiology* ; Retrospective Studies ; Spinal Neoplasms/mortality ; Spinal Neoplasms/secondary ; Spinal Neoplasms/surgery* ; Treatment Outcome ; Young Adult
Keywords
Perioperative complication ; Spinal metastasis ; Surgery
Abstract
OBJECTIVE: Metastatic spinal disease requires a multidisciplinary approach with advanced surgical techniques which improve longevity and the quality of life. The purpose of this study is to compare the surgical outcomes and perioperative complications and mortality among en bloc, debulking, and palliative surgeries in patients with spinal metastasis. METHODS: From 2005 to 2010, 200 patients who underwent surgical treatment for spinal metastases were enrolled retrospectively. Clinical analysis included primary cancer type, survival following the diagnosis of cancer, postoperative survival, Tokuhashi score, postoperative functional status, postoperative complications and mortality depending on the surgery type. Enrolled patients were divided into 3 groups: en bloc excision, debulking curettage, and palliative surgery. Surgical outcomes including perioperative complication and mortality were compared based on the surgery type. RESULTS: The mean age was 59.9 years (range 21-87). The major types of primary cancer were lung (42 cases), liver (27 cases), and colorectal cancer (27 cases). 62 surgeries (31.0%) were en bloc excisions, 82 (41.0%) were debulking, and 56 (28.0%) were palliative operations. The mean Tokuhashi score was 9.2±3.3 in the en bloc group, 7.2±3.0 in the debulking group and 8.2±2.6 in the palliative group (p=0.001, ANOVA). Mean postoperative survivals were 17.9±22.1 months in the en bloc group, 7.0±11.7 months in the debulking group and 8.5±10.8 months in the palliative group (p=0.022, ANOVA). There were 8 (12.9%) postoperative complications in the en bloc group, 17 (20.7%) in the debulking group, and 8 (14.3%) in the palliative group (p=0.016, chi-square). Three patients (4.8%) in the en bloc group had multiple complications, as did 5 (6.1%) in the debulking group and 2 (3.6%) in the palliative group (p=0.925, chi-square). Among 21 total perioperative deaths, 6 (28.6%) were in the en bloc group, 10 (47.6%) in the debulking group, and 5 (23.8%) in the palliative group (p=0.618, chi-square). CONCLUSION: Postoperative complications were most common in the debulking group compared to the 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 is of great significance in the planning stage of the surgery.
Full Text
http://www.sciencedirect.com/science/article/pii/S0303846714001590
DOI
10.1016/j.clineuro.2014.04.025
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hak Sun(김학선) ORCID logo https://orcid.org/0000-0002-8330-4688
Moon, Seong Hwan(문성환)
Park, Jin Oh(박진오)
Lee, Byung Ho(이병호) ORCID logo https://orcid.org/0000-0001-7235-4981
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98841
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