Surgical Treatment of Metastatic Bone Disease in the Appendicular Skeleton: A Population-Based Study

Hovgaard, Thea Bechmann; Sørensen, Celine Lykke; Nielsen, Rasmus; Troelsen, Anders; Al-Mousawi, Dhergam Ahmed Ali; Bielefeldt, Rikke; Petersen, Michael Mørk; Sørensen, Michala Skovlund

doi:10.3390/cancers14051258

Cited by 3 publications

(4 citation statements)

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“…Instead, they found fast-growth primary cancers, visceral metastases, no chemotherapy after surgery, and implant type to be risk factors for death. The described increased risk of 30-day mortality for patients having IF is probably a result of bias in the selection of surgical treatment for patients with a poor prognosis who tend to undergo less invasive surgery [ 18 ], as illustrated in Table 1 , describing differences between patients treated with EPR and IF. Furthermore, patients undergoing IF for aBM in the femur may be limited in immediate weightbearing due to the painful lesion if not removed.…”

Section: Discussionmentioning

confidence: 99%

“…We found a 30-day survival probability of 85% (CI 81–88), slightly lower than found in our previous study [ 11 ]. This is probably explained by the present study including patients treated at secondary surgical centers, who are shown to have significantly poorer survival than patients treated at a highly specialized center [ 18 ]. Tsuda et al [ 10 ] report a 30-day mortality after surgery for metastatic lesions in the femur of 2.6%, which is considerably lower than ours.…”

Section: Discussionmentioning

confidence: 99%

“…We conducted a retrospective population-based cohort study on all patients from the Capital Region of Denmark (CRD) between January 1, 2014 and December 31, 2019. It is based on a previously described population-based cohort [ 18 ], receiving surgical treatment for aBM. Also, patients with hematological diseases that affected the bone, such as myeloma and lymphoma, were included as they underwent similar surgical procedures.…”

Section: Methodsmentioning

confidence: 99%

“…Visceral metastases and the number of bone metastases were not included in the analysis for 30-day mortality in our previous study but were included now based on findings in the literature for overall survival [7,10,[21][22][23][24]. Type of fracture (complete or impending) was included in the analysis based on findings in the literature, reporting differences in survival between these [7,18]. All the variables mentioned were used as predictive variables for the outcome, 30-day mortality, in logistic regression.…”

Section: Data Collection and Variablesmentioning

confidence: 99%

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Major surgery for metastatic bone disease is not a risk for 30-day mortality: a population-based study from Denmark

Ladegaard,

Sørensen,

Petersen

2023

ActaO

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Background and purpose: Surgery for bone metastases in the appendicular skeleton (aBM) is a trade-off between limb function and survival. A previous study from a highly specialized center found that extended surgery is not a risk for 30-day mortality and hypothesized that wide resection and reconstruction might reduce postoperative mortality. The study aimed to investigate whether parameters describing the surgical trauma (blood loss, duration of surgery, and degree of bone resection) pose a risk for 30-day mortality in patients treated with endoprostheses (EPR) or internal fixation (IF) in a population-based cohort.Patients and methods: A population-based cohort having EPR/IF for aBM in the Capital Region of Denmark 2014–2019 was retrospectively assessed. Intraoperative variables and patient demographics were evaluated for association with 30-day mortality by logistic regression analysis. Kaplan–Meier estimate was used to evaluate survival with no loss to follow-up.Results: 437 patients had aBM surgery with EPR/IF. No parameters describing the magnitude of the surgical trauma (blood loss/duration of surgery/degree of bone resection) were associated with mortality. Overall 30-day survival was 85% (95% confidence interval [CI] 81–88). Univariate analysis identified ASA group 3+4, Karnofsky score < 70, fast-growth primary cancer, and visceral and multiple bone metastases as risk factors for 30-day mortality. Male sex (OR 2.8, CI 1.3–6.3), Karnofsky score < 70 (OR 4.2, CI 2.1–8.6), and multiple bone metastases (OR 3.4, CI 1.2–9.9) were independent prognostic factors for 30-day-mortality in multivariate analysis.Conclusion: The parameters describing the surgical trauma were not associated with 30-day mortality but, instead, general health status and extent of primary cancer influenced survival post-surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Data Collection and Variablesmentioning

confidence: 99%

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Major surgery for metastatic bone disease is not a risk for 30-day mortality: a population-based study from Denmark

Ladegaard,

Sørensen,

Petersen

2023

ActaO

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Risk Factors for Early Postoperative Morbidity and Mortality following Extremity Metastatic Pathologic or Impending Fracture Fixation

Wang,

Charron,

Hali

et al. 2024

International Journal of Surgical Oncology

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Background. As cancer survivorship continues to improve, the perioperative morbidity and mortality following surgical treatment of metastatic bone disease become an increasingly important consideration. The objective of this study is to identify risk factors for early postoperative complications and mortality following extremity prophylactic fixation and pathologic fracture stabilization. Methods. A single‐centre retrospective review of 185 patients (226 total surgeries) who underwent prophylactic fixation or pathologic fracture stabilization for extremity metastatic bone disease between 2005 and 2020 was performed. Skull, spine, pelvic, and revision surgeries along with diagnosis of primary bone neoplasm were excluded. Univariate, multivariate, and subgroup analyses were performed to identify predictors and independent risk factors for 30‐day postoperative morbidity and mortality. Results. Primary cancers included lung (n = 41), breast (n = 36), multiple myeloma (n = 35), prostate (n = 16), lymphoma (n = 11), renal cell carcinoma (n = 10), and other (n = 36). The 30‐day postoperative complication and mortality rates were 32.30% (n = 73) and 17.26% (n = 39), respectively. The most common complications were pulmonary‐related, cardiac events, surgical site infection, sepsis, and thromboembolism. Pathologic fracture, presence of extra‐skeletal metastases, longer surgical duration, and blood transfusion requirements were associated with 30‐day postoperative complications overall. A past medical history for cardiac disease was also associated with systemic but not local surgical complications. Pathologic fracture, presence of extra‐skeletal metastases, lung cancer, blood transfusion requirements, and increasing pack‐year smoking history were predictors for 30‐day mortality. In the multivariate analysis, pathologic fracture (p = 0.016) and presence of extra‐skeletal metastases (p = 0.029) were independent predictors of complications. For mortality, pathologic fracture (p = 0.014), presence of extra‐skeletal metastases (p = 0.0085), and increased blood transfusion requirements (p = 0.048) were independent risk factors. Conclusions. The findings of this study provide additional guidance for perioperative risk assessment and patient counselling. Additionally, improving clinical assessment tools to identify and quantify patients at risk of pathologic fractures becomes increasingly important given the significant morbidity and mortality associated with pathologic fracture treatment.

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Solitary versus multiple bone metastases in the appendicular skeleton

Ladegaard,

Sørensen,

Petersen

2023

Bone Joint J

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AimsWe first sought to compare survival for patients treated surgically for solitary and multiple metastases in the appendicular skeleton, and second, to explore the role of complete and incomplete resection (R0 and R1/R2) in patients with a solitary bony metastasis in the appendicular skeleton.MethodsWe conducted a retrospective study on a population-based cohort of all adult patients treated surgically for bony metastases of the appendicular skeleton between January 2014 and December 2019. We excluded patients in whom the status of bone metastases and resection margin was unknown. Patients were followed until the end of the study or to their death. We had no loss to follow-up. We used Kaplan-Meier analysis (with log-rank test) to evaluate patient survival. We identified 506 operations in 459 patients. A total of 120 operations (in 116 patients) were for solitary metastases and 386 (in 345 patients) for multiple metastases. Of the 120 operations, 70 (in 69 patients) had no/an unknown status of visceral metastases (solitary group) and 50 (in 49 patients) had visceral metastases. In the solitary group, 45 operations (in 44 patients) were R0 (resections for cure or complete remission) and 25 (in 25 patients) were R1/R2 (resections leaving microscopic or macroscopic tumour, respectively). The most common types of cancer in the solitary group were kidney (n = 27), lung (n = 25), and breast (n = 20).ResultsThe one-year patient survival was 47% (95% confidence interval (CI) 38 to 57) for the solitary bony metastases and 34% (95% CI 29 to 39) for multiple bone metastases (p < 0.001). The one-year patient survival was 64% (95% CI 52 to 75) for solitary bony metastases without/with unknown visceral metastases and 23% (95% CI 11 to 36) for solitary bony metastases with visceral metastases (p < 0.001). The one-year patient survival was 75% (95% CI 62 to 89) for a solitary bony metastasis after R0 surgery and 42% (95% CI 22 to 61) for a solitary bony metastasis with R1/R2 surgery (p < 0.001).ConclusionOur study suggests that the surgical treatment of patients with a solitary bony metastasis to the appendicular skeleton results in better survival than for patients with multiple bony metastases. Furthermore, aggressive treatment of a solitary bony metastasis with R0 surgery may improve patient survival.Cite this article: Bone Joint J 2023;105-B(11):1206–1215.

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Surgical Treatment of Metastatic Bone Disease in the Appendicular Skeleton: A Population-Based Study

Cited by 3 publications

References 41 publications

Major surgery for metastatic bone disease is not a risk for 30-day mortality: a population-based study from Denmark

Major surgery for metastatic bone disease is not a risk for 30-day mortality: a population-based study from Denmark

Risk Factors for Early Postoperative Morbidity and Mortality following Extremity Metastatic Pathologic or Impending Fracture Fixation

Solitary versus multiple bone metastases in the appendicular skeleton

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