Factors Associated With Improved Outcomes Following Decompressive Surgery for Prostate Cancer Metastatic to the Spine

Ju, Derek G; Zadnik, Patricia L.; Groves, Mari L.; Hwang, Lee; Kaloostian, Paul E.; Wolinksy, Jean Paul; Witham, Timothy F.; Bydon, Ali; Gokaslan, Ziya L.; Sciubba, Daniel M.

doi:10.1227/neu.0000000000000070

Cited by 41 publications

(68 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3 did not find a statistically significant difference in the incidence rate of complications among spinal metastases based on primary tumor site. However, Ju et al 15 reported that younger age (p < 0.01) and instrumentation greater than 7 spinal levels (p = 0.03) were associated with increased odds of complication in patients with MESCC stemming from prostate cancer. Quraishi et al 36 compared complication rates based on timing of surgery and determined that the incidence of complications was similar among those treated with surgery within 24 hours (40% complication rate), between 24 and 48 hours (43%), and over 48 hours (42%) following acute presentation of neurological symptoms (p = 1.0).…”

Section: Complicationsmentioning

confidence: 99%

“…2,3,5,7,15,18,19,21,25,28,[30][31][32]34,35,37,38,40,43 Of these, 16 studies were retrospective; 1 was a longitudinal observational study; 1 was a randomized, multiinstitutional, nonblinded trial; and 1 was a semiprospective study that included both retrospectively and prospectively collected data. Surgical interventions included decompression with and without instrumentation and radiotherapy.…”

Section: Predictors Of Survivalmentioning

confidence: 99%

“…15,17,32,[36][37][38]45 The most common primary tumor sites included prostate cancer (6 studies), lung cancer (6 studies), breast cancer (5 studies), and renal cancer (3 studies). Five of the studies were retrospective and 2 were prospective.…”

Section: Miscellaneousmentioning

confidence: 99%

See 2 more Smart Citations

Decompression surgery for spinal metastases: a systematic review

Bakar

Tanenbaum

Phan

et al. 2016

FOC

View full text Add to dashboard Cite

OBJECTIVE The aim of this study was to systematically review the literature on reported outcomes following decompression surgery for spinal metastases. METHODS The authors conducted MEDLINE, Scopus, and Web of Science database searches for studies reporting clinical outcomes and complications associated with decompression surgery for metastatic spinal tumors. Both retrospective and prospective studies were included. After meeting inclusion criteria, articles were categorized based on the following reported outcomes: survival, ambulation, surgical technique, neurological function, primary tumor histology, and miscellaneous outcomes. RESULTS Of the 4148 articles retrieved from databases, 36 met inclusion criteria. Of those included, 8 were prospective studies and 28 were retrospective studies. The year of publication ranged from 1992 to 2015. Study size ranged from 21 to 711 patients. Three studies found that good preoperative Karnofsky Performance Status (KPS ≥ 80%) was a significant predictor of survival. No study reported a significant effect of time-to-surgery following the onset of spinal cord compression symptoms on survival. Three studies reported improvement in neurological function following surgery. The most commonly cited complication was wound infection or dehiscence (22 studies). Eight studies reported that preoperative ambulatory or preoperative motor status was a significant predictor of postoperative ambulatory status. A wide variety of surgical techniques were reported: posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. Although a wide range of functional scales were used to assess neurological outcomes, four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function. Four studies reported the effects of radiation therapy and local disease control for spinal metastases. Two studies reported that the type of treatment was not significantly associated with the rate of local control. The most commonly reported primary tumor types included lung cancer, prostate cancer, breast cancer, renal cancer, and gastrointestinal cancer. CONCLUSIONS This study reports a systematic review of the literature on decompression surgery for spinal metastases. The results of this study can help educate surgeons on the previously published predictors of outcomes following decompression surgery for metastatic spinal disease. However, the authors also identify significant gaps in the literature and the need for future studies investigating the optimal practice with regard to decompression surgery for spinal metastases.

show abstract

Section: Complicationsmentioning

confidence: 99%

Section: Predictors Of Survivalmentioning

confidence: 99%

See 1 more Smart Citation

Decompression surgery for spinal metastases: a systematic review

Bakar

Tanenbaum

Phan

et al. 2016

FOC

View full text Add to dashboard Cite

show abstract

“…1,13,14,16,17,26,27,30,31,38,63,93,[95][96][97][98] However, surgical approaches to spinal tumors often necessitate extensive reconstruction of the spinal column and may require adjuvant chemotherapy or radiation; therefore, perioperative complication rates after spinal tumor surgery are higher than in other spinal operations. [34][35][36][46][47][48]50,52,65,67,68,78,80,81,[86][87][88]95,100 It is especially important to understand the incidence and predictive factors for adverse events in spinal oncology patients, as a single complication may be associated with morbidity, mortality, and costs. 1,31,37,46,47,52,62,70,72,79,86,95 Risk stratification of patients preoperatively is important to optimize outcomes, …”

mentioning

confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

View full text Add to dashboard Cite

OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

show abstract

“…Algumas variáveis como idade, carga tumoral, expectativa de vida e capacidade funcional influenciarão na escolha das opções terapêuticas (SCIUBBA; GOKASLAN, 2006;JU et al, 2013).…”

Section: Diagnóstico E Tratamentounclassified

Pacientes com metástases vertebrais submetidos à cirurgia - avaliação da qualidade de vida relacionada à saúde

Andrade¹

View full text Add to dashboard Cite

Factors Associated With Improved Outcomes Following Decompressive Surgery for Prostate Cancer Metastatic to the Spine

Cited by 41 publications

References 38 publications

Decompression surgery for spinal metastases: a systematic review

Decompression surgery for spinal metastases: a systematic review

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Pacientes com metástases vertebrais submetidos à cirurgia - avaliação da qualidade de vida relacionada à saúde

Contact Info

Product

Resources

About