gms | German Medical Science

Objective: The purpose of this study is to compare the surgical outcomes, perioperative complications and mortality of en bloc, debulking, and palliative surgeries in patients with spinal metastasis (SM).

Method: From 2008 to 2014, 127 patients, who underwent surgical treatment for SM were enrolled retrospectively. Clinical analysis included primary cancer type, survival following spinal surgery, pre- and postoperative pain, Frankel and ECOG scores, perioperative complications and mortality depending on the type of surgery. Patients were grouped into: wide (en bloc) excision, debulking resection, and palliative (decompressive with or with instrumentation).

Results: The major types of primary tumor were lung (28%), prostate (15%), breast (12%) renal (11%) and gastrointestinal (9%) cancer. 54% presented in good clinical conditions (ECOG 0-1). 25% were in the good prognosis group, 22% in the intermediate and 54% in the poor prognosis group as classified by the revised Tokuhashi score. 16% of the operations were performed for cervica metastases, 60% for thoracic, and 24% for thoracolumbal or lumbosacral SM. 18% were en bloc excisions, 11% were intralesional resections, and 81% were palliative operations. In 50 patients, dorso- or dorsoventral instrumentation was necessary. In 19% of patients, single or multiple complications occurred. In-hospital mortality was 4,4%. 48-months survival rates were 55% in the en bloc and 68% in the intralesional resection group, and mean postsurgical survival was 12,03 months for patients receiving palliative surgery (p<0,0001). Mean survival times were significantly dependent on presurgical ECOG (p<0,0001) and the revised Tokuhashi score (p<0,0001). The kind and number of complications and clinical outcome did not correlate with the surgical groups. After surgery worsened ECOG and Frankel scores were associated with interventions of the thoracic spine (p=0,0163 and p=0,06, respectively). The greatest neurological benefit and the longest survival rates (24,13 months) were achieved for cervical interventions (versus 12,12 and 6,4 months for thoracic and lumbar metastatic disease), independently of the surgical group and presurgical ECOG and Tokuhashi scores.

Conclusions: The best surgical outcome for metastatic disease of the spine can be achieved in tumors affecting the cervical region, whereas patients with thoracic metastases more often suffer from neurological and clinical postsurgical worsening. Perisurgical complications as well as neurological outcome is independent of the extend of surgical resection and histology.