Outcomes and strategies for surgical management of metastatic spinal tumors

Haomiao Li, Alessandro Gasbarrini, Michele Cappuccio, Loris Mirabile, Stenfania Paderni, Silvia Terzi, Stefano Boriani

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Abstract

Objective: To report the outcome of a new surgical strategy for metastatic spinal tumors and to discuss the characteristics and feasibility of this strategy. Methods: From January 1996 to December 2006, 249 patients with spinal metastasis underwent surgical treatment in the Department of Orthopedics and Traumatology-Spine Surgery of Ospedale Maggiore, Bologna. There were 152 men and 97 women. The average age was 57 years. A new surgical strategy was examined in this study. According to this strategy, feasibility judgments were based on the anesthetic evaluation. Patients with lower potential risk for surgery were judged to be operable, whereas those with high potential risk for surgery were judged to be inoperable. Reversible neurological deficit, pathological fracture , intractable pain and insensitivity to the adjunctive therapies were all considered when making the judgment. The surgeries included 3 main procedures: palliative surgery, curettage surgery and en bloc surgery. Results: One patient died during the procedure and six patients died within 1 month after the procedure. Among the patients, 91.7% had pain that was relieved and 88.4% had neurological functions improve immediately after the operation. There were 215 patients who were followed up with a mean time of 20.4 months and the median survival duration was 20.9±2.7 months. Among the patients followed up, 84.8% achieved local control. Conclusion: The main purpose of surgical management of spinal metastases is to improve the quality of life. It was found that reasonable surgeries can significantly improve the survival time and quality of life. The preoperative anesthetic evaluation is critical for improved safety. However, the mathematic scoring systems in use are not appropriate to use for determining strategy for spinal metastasis management. The present individualized and flexible strategy, which not only takes advantage of the surgeries but also emphasizes the effects of the adjunctive therapies, is more scientific and reasonable so good surgical outcomes can be achieved if this plan is used.

Original languageEnglish
JournalChinese Journal of Clinical Oncology
Volume37
Issue number21
DOIs
Publication statusPublished - Nov 15 2010

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Keywords

  • General surgery
  • Metastasis
  • Neoplasm
  • Prognosis
  • Spine

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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