A scoping review on the surgical management of metastatic bone disease of the extremities

Abstract

BackgroundManagement of metastatic bone disease of the extremities (MBD-E) is challenging, and surgical directions pose significant implications for overall patient morbidity and mortality. Recent literature reviews on the surgical management of MBD-E present a paucity of high-level evidence and global inconsistencies in study design. In order to steer productive research, a scoping review was performed to map and assess critical knowledge gaps.MethodsThe Arksey and O’Malley framework for scoping studies was followed. A comprehensive literature search identified a large body of literature pertaining to the surgical management of MBD-E. Study data and meta-data was extracted and presented using descriptive analytics and a thematic framework. Literature gaps were identified and analyzed.ResultsThree hundred eighty five studies from 1969 to 2017 were included. Studies were categorized into 11 separate themes, with the majority (63%) falling into the “surgical fixation strategies” theme, followed by “complications” at 7% and “prognosis and survival” at 6.2%. Less than 3% of studies were categorized in “patient related outcomes” or “epidemiology” themes. 89% of studies were retrospective and only 6 studies were of level 1 or 2 evidence. We identified a temporal increase in publication by decade, and all studies published on interventional radiology techniques or economic analyses were published after 2007 or 2009, respectively. 64.9% of studies were published in Europe and 20.3% were published in North America. Average patient age was 62 (± 5.2 years), and breast was the most common primary tumour (28%), followed by lung (17%) and kidney (15%). In terms of surgical location, 75% of operations involved the femur, followed by the humerus at 22% and tibia at 3%.ConclusionsWe present a descriptive overview of the current published literature on the surgical management of MBD-E. Critical knowledge gaps have been identified through the development of a thematic framework. Consolidation of literary gaps must involve bolstered efforts towards patient and family-engaged research initiatives and assessment of patient-related surgical outcomes. Multi-disciplinary engagement in developing prospective research will also help guide evidence-based personalized practice for these patients. By building on existing comprehensive patient databases and registries, knowledge on survival and prognostic parameters can be greatly improved.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2210-8) contains supplementary material, which is available to authorized users.

Current concepts in the surgical treatment of skeletal metastases

“…The humerus is the second most common site for MBD of the long bones[ 9 ]. Standard surgical options are the same as for the femur.…”

“…Despite the fact that MBD severely affects a large group of palliative patients and is a driver of overall oncology cost[ 8 ], research is scarce and mainly consists of retrospective case series which are heterogenous and difficult to draw conclusions from. Solid evidence is lacking in almost every field, from surgical management to adjuvant treatment[ 9 - 12 ].…”

Does surgical technique influence the burden of lung metastases in patients with pathologic long bone fractures?

“…Other potential confounding factors not analyzed include use of concomitant therapies such as chemotherapy, radiation therapy and immunotherapies, as well as the presence of visceral metastasis, and overall patient systemic health and functional status. This further emphasizes the need for using large, multi-center databases to study this heterogeneous disease process, to utilize appropriate power estimates and detect differences not only amongst the entire pooled cohort, but importantly amongst the individual primary cancer types [ 18 ].…”

Current concepts in metastatic carcinoma: a review of the literature

“…In the appendicular skeleton, bone metastases usually involve the proximal long bones, most frequently the femur, followed by the humerus and tibia. 2…”