Anesth Pain Med.  2018 Apr;13(2):222-231. 10.17085/apm.2018.13.2.222.

Preliminary study of anesthetic risk factors in surgery for pathologic fractures secondary to metastatic tumors

• Kim TK
• Yoon JR
• Noh Y
• Yoon HJ
• Park MS
• Kim YH

• KMID: 2437433
• DOI: http://doi.org/10.17085/apm.2018.13.2.222

Abstract

BACKGROUND
Despite advances in the treatment of primary cancer, metastatic pathologic fractures still affect the survival of cancer patients. The goals of surgery, such as those with terminal cancer, are to maintain a maximum level of independence and improve the quality of life. A patient may be a poor surgical candidate because of a short life expectancy or illness that is too severe to benefit from surgical fixation. Moreover, this surgery is an operation accompanied with significant morbidity and mortality. This retrospective study investigated the characteristics of these patients and assessed the influence of anesthetic risk factors on the outcome.
METHODS
The records of 45 patients with pathologic fractures who underwent surgical stabilization for metastatic factors from 1 January 1995 to 31 December 2013 at our hospital were reviewed. Demographic data, various severity scores, anesthetic factors, and survival were reviewed.
RESULTS
The most common sites of primary tumors were lung, liver and stomach. The predominant sites of pathologic fractures were the femur (71.1%); six lesions were in the humerus and four in the spine. Univariate and multivariate analyses identified several prognostic factors with a significantly worse influence on survival, including lung tumor and Acute Physiology and Chronic Health Evaluation (APACHE) II score.
CONCLUSIONS
Although the number of patients was too small to result in a satisfactory appraisal, the most important step is to select candidates to gain the benefits of palliative surgery. We suggest the possibility of APACHE II scoring and the recognition of lung cancer in making the clinical decision of performing the palliative osteosyntheses for patients with pathologic fractures.

Keyword

Anesthesia; Cancer; Pathologic fracture; Survival

MeSH Terms

Anesthesia
APACHE
Femur
Fractures, Spontaneous*
Humans
Humerus
Life Expectancy
Liver
Lung
Lung Neoplasms
Mortality
Multivariate Analysis
Palliative Care
Quality of Life
Retrospective Studies
Risk Factors*
Spine
Stomach

Figure

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  Fig. 1 Kaplan-Meier survival curves according to the number of additional organ metastasis.

• 

  Fig. 2 Kaplan-Meier survival curves comparing between lung cancer and other cancers.

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