J Korean Soc Spine Surg.  2019 Sep;26(3):84-93. 10.4184/jkss.2019.26.3.84.

Surgical Extent of Metastatic Spine Tumor Excision and Its Effects on Postoperative Ambulatory Function: Comparison of Extensive Wide versus Palliative Excision Surgery

• Kim SI
• Ha KY
• Oh IS
• Park HY
• Kang KH
• Jeon WK
• Kim YH

• KMID: 2459757
• DOI: http://doi.org/10.4184/jkss.2019.26.3.84

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To compare surgical outcomes such as the ambulatory period and survival according to different surgical excision tactics for metastatic spine tumors (MSTs). SUMMARY OF LITERATURE REVIEW: Surgical outcomes, such as pain relief and survival, in patients with MSTs have been reported in several studies, but the effects of differences in surgical extent on the ambulatory period have rarely been reported.
MATERIALS AND METHODS
Ninety-six patients with MSTs who underwent palliative (n=60) or extensive wide excision (n=36) were included. Palliative excision was defined as partial removal of the tumor as an intralesional piecemeal procedure for decompression. Extensive wide excision was defined as a surgical attempt to remove the whole tumor at the index level as completely as possible. The primary outcome was the ambulatory period following surgery. Other demographic and radiographic parameters were analyzed to identify the risk factors for loss of ambulatory ability and survival. Perioperative complications were also assessed.
RESULTS
The mean postoperative ambulatory period was longer in the extensive wide excision group (average 14.8 months) than in the palliative excision group (average 11.7 months) (p=0.021). The survival rates were not significantly different between the two surgical excision groups (p=0.680). However, postoperative ambulatory status and major complications within 30 days postoperatively were significant prognostic factors for survival (p=0.003 and p=0.032, respectively).
CONCLUSIONS
The extent of surgical excision affected the ambulatory period, and the complication rates were similar, regardless of surgical excision tactics. A proper surgical strategy to achieve postoperative ambulatory ability and to reduce perioperative complications would have a favorable effect on survival.

Keyword

Metastatic spine tumor; Surgical extent; Palliative; Wide; Ambulation

MeSH Terms

Decompression
Humans
Retrospective Studies
Risk Factors
Spine*
Survival Rate
Walking

Figure

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  Fig. 1. Distribution of primary solid cancers. The most common primary cancer was lung cancer (n=35, 36.5%), followed by hepatobiliary cancer (n=25, 26.0%).

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  Fig. 2. Kaplan-Meier curve of the postoperative ambulatory period according to the extent of surgical excision. Patients in the W group could walk for an average of 14.8±1.5 months after surgery (95% CI, 11.9-17.7 months), and patients in the P group could walk for an average of 11.7±1.7 months after surgery (95% CI, 8.3-15.0 months). Surgical extent significantly affected the postoperative ambulatory period (p=0.021).

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  Fig. 3. Kaplan-Meier curve of the survival rate according to the extent of surgical excision. Surgical extent did not affect the survival rate (p=0.689).

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