Aims. Frailty has been gathering attention as a factor to predict surgical outcomes. However, the association of frailty with postoperative complications remains controversial in spinal metastases surgery. We therefore designed a prospective study to elucidate risk factors for postoperative complications with a focus on frailty. Methods. We prospectively analyzed 241 patients with spinal metastasis who underwent
The April 2024 Oncology Roundup360 looks at: Midterm outcomes of total hip arthroplasty after internal hemipelvectomy and iliofemoral arthrodesis; Intraosseous conventional central chondrosarcoma does not metastasize irrespective of grade in pelvis, scapula, and in long bone locations; Oncological and functional outcomes after resection of malignant tumours of the scapula; Reconstruction following oncological iliosacral resection – a comparison of techniques; Does primary tumour resection improve survival for patients with sarcomas of pelvic bones, sacrum, and coccyx who have metastasis at diagnosis?; Older patients with Ewing’s sarcoma: an analysis of the National Cancer Database; Diagnostic challenges in low-grade central osteosarcoma; Effect of radiotherapy on local recurrence, distant metastasis, and overall survival in 1,200 limb soft-tissue sarcoma patients: a retrospective analysis using inverse probability of treatment weighting-adjusted models.
The aim of this study was to assess the clinical and radiological outcomes of an antiprotrusio acetabular cage (APC) when used in the surgical treatment of periacetabular bone metastases. This retrospective cohort study using a prospectively collected database involved 56 patients who underwent acetabular reconstruction for periacetabular bone metastases or haematological malignancy using a single APC between January 2009 and 2020. The mean follow-up was 20 months (1 to 143). The primary outcome measure was implant survival. Postoperative radiographs were analyzed for loosening and failure. Patient and implant survival were assessed using a competing risk analysis. Secondary parameters included primary malignancy, oncological treatment, surgical factors, length of stay in hospital, and postoperative complications.Aims
Methods
Time to treatment initiation (TTI) is generally defined as the time from the histological diagnosis of malignancy to the initiation of first definitive treatment. There is no consensus on the impact of TTI on the overall survival in patients with a soft-tissue sarcoma. The purpose of this study was to determine if an increased TTI is associated with overall survival in patients with a soft-tissue sarcoma, and to identify the factors associated with a prolonged TTI. We identified 23,786 patients from the National Cancer Database who had undergone definitive surgery between 2004 and 2015 for a localized high-grade soft-tissue sarcoma of the limbs or trunk. A Cox proportional hazards model was used to examine the relationship between a number of factors and overall survival. We calculated the incidence rate ratio (IRR) using negative binomial regression models to identify the factors that affected TTI.Aims
Methods
Aims. With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values. Methods. We prospectively analyzed 101 patients with spinal metastases who underwent
Survival rates and local control after resection of a sarcoma of the pelvis compare poorly to those of the limbs and have a high incidence of complications. The outcome for patients who need a hindquarter amputation (HQA) to treat a pelvic sarcoma is poor. Our aim was to evaluate the patient, tumour, and reconstructive factors that affect the survival of the patients who undergo HQA for primary or recurrent pelvic sarcoma. We carried out a retrospective review of all sarcoma patients who had undergone a HQA in a supraregional sarcoma unit between 1996 and 2018. Outcomes included oncological, surgical, and survival characteristics.Aims
Methods
In this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from metastatic bone disease, and compared these FE predictions with clinical assessments by experienced clinicians. A total of 39 patients with non-fractured femoral metastatic lesions who were irradiated for pain were included from three radiotherapy institutes. During follow-up, nine pathological fractures occurred in seven patients. Quantitative CT-based FE models were generated for all patients. Femoral failure load was calculated and compared between the fractured and non-fractured femurs. Due to inter-scanner differences, patients were analyzed separately for the three institutes. In addition, the FE-based predictions were compared with fracture risk assessments by experienced clinicians.Objectives
Methods
Surgical intervention in patients with bone metastases from breast
cancer is dependent on the estimated survival of the patient. The
purpose of this paper was to identify factors that would predict
survival so that specific decisions could be made in terms of surgical
(or non-surgical) management. The records of 113 consecutive patients (112 women) with metastatic
breast cancer were analysed for clinical, radiological, serological
and surgical outcomes. Their median age was 61 years (interquartile
range 29 to 90) and the median duration of follow-up was 1.6 years
(standard deviation (Aims
Methods
We investigated the functional outcome in patients
who underwent reverse shoulder replacement (RSR) after removal of
a tumour of the proximal humerus. A total of 16 patients (ten women
and six men) underwent this procedure between 1998 and 2011 in our
hospital. Five patients died and one was lost to follow-up. Ten
patients were available for review at a mean follow-up of 46 months
(12 to 136). Eight patients had a primary and two patients a secondary
bone tumour. At final follow up the mean range of active movement was: abduction
78° (30° to 150°); flexion 98° (45° to 180°); external rotation
32° (10° to 60°); internal rotation 51° (10° to 80°). The mean Musculoskeletal
Tumor Society score was 77% (60% to 90%) and the mean Toronto Extremity
Salvage Score was 70% (30% to 91%). Two patients had a superficial
infection and one had a deep infection and underwent a two-stage
revision procedure. In two patients there was loosening of the RSR;
one dislocated twice. All patients had some degree of atrophy or
pseudo-atrophy of the deltoid muscle. Use of a RSR in patients with a tumour of the proximal humerus
gives acceptable results. Cite this article:
Aims. Bone is a common site of metastatic disease. Skeletal complications include disabling pain and pathological fractures.
The aim of this study was to define the treatment
criteria for patients with recurrent chondrosarcoma. We reviewed the
data of 77 patients to examine the influence of factors such as
the intention of treatment (curative/palliative), extent of surgery,
resection margins, status of disease at the time of local recurrence
and the grade of the tumour. A total of 70 patients underwent surgery
for recurrent chondrosarcoma. In seven patients surgery was not
a viable option. Metastatic disease occurred in 41 patients, appearing
synchronously with the local recurrence in 56% of cases. For patients
without metastasis at the time of local recurrence, the overall
survival at a mean follow-up after recurrence of 67 months (0 to
289) was 74% (5 of 27) compared with 19% (13 of 50) for patients
with metastasis at or before the development of the recurrence.
Neither the type/extent of surgery, site of tumour, nor the resection margins
for the recurrent tumour significantly influenced the overall survival. With limited survival for patients with metastatic disease at
the time of local recurrence (0% for patients with grade III and
de-differentiated chondrosarcoma), palliative treatment, including
local radiation therapy and debulking procedures, should be discussed
with the patients to avoid long hospitalisation and functional deficits. For
patients without metastasis at the time of local recurrence, the
overall survival of 74% justifies an aggressive approach including
wide resection margins and extensive reconstruction.
Introduction and purpose: The most frequent neurological complication of humeral fractures is radial nerve palsy. Most patients with humeral fractures and radial nerve palsy recover with conservative treatment. But a small percentage of patients require surgical treatment; these are patients who show no clinical improvement of their nerve lesion after 3 months of conservative treatment, those with an open fracture, an associated vascular lesion, secondary radial palsy or patients who require open fracture osteosynthesis. The aim of this study is to assess and analyze humeral fractures with radial palsy that have required surgical treatment. Materials and methods: A prospective pre and postoperative study with a protocol was carried out between 1999 and 2007 in which 28 patients with humeral fractures and radial palsy required surgical treatment. Of the patients studied 10 were women and 18 were men. Their ages varied from 18 to 74 years of age. As to the type of radial palsy, it was primary in 11 patients, secondary in 2 patients (included in the fracture callus) and postoperative in 15. Neurolysis was performed in 20 patients and fascicular grafts were used in 8. Results: Time to fracture healing was 14.2 + 5.6 weeks. The period of radial nerve recovery was 7.2 + 5.7 months. Neurolysis was performed in 20 patients and fascicular grafts in 8. There were 20 complete recoveries, 4 incomplete but useful, in 4 cases there was no recovery and
Introduction An international six-centre prospective observational cohort study. Objective. To assess the feasibility of radical surgical excisional treatment of spinal metastasis. Materials and methods. Patients with histologically confirmed spinal metastasis originating from epithelial primary site mostly treated with instrumented surgery were studied. Surgical strategies were either radical excisional (enbloc and debulking) or
Purpose of the study: We report a series of 12 patients who underwent surgery in 2003 or 2004 for spinal shortening as treatment for thoracic or lumbar metastasis. Material and method: This series included seven females and five males, mean age 56.5 years (range 34–80 years). The operation was a resection of the vertebral body in a one-stage procedure. A simple posterior approach was used for two patients and a wider costotransversectomy approach was required for ten. Posterior fixation was installed with pedicle screws in the two vertebrae above and two below the resection. Mean operative time was 343 minutes (range 260–420 min). Mean blood loss was 2380 cc (range 600–5000). There were few surgery-related complications: one dural breach and one pulmonary breach. Results: The decision to undertake surgery was made on the basis of neurological problems in seven patients. All patients were Frankel class C, unable to walk. Among these patients, five died in less than six months. For the two survivors, they were scored 7 on the Tokuhashi scale. The remainder scored 5. For the two survivors, one recovered walking capacity (Frankel D) and the other achieved a normal status (Frankel E). The five other patients underwent surgery for pain related to a kyphosis callus threatening the cord. We used the Karnofsky and the Oswestry score to analyze outcome. The score did not regress in any of the patients after surgery. Three patients improved their score significantly. The three others had an unchanged score. The best correction of the kyphosis callus was obtained when the vertebral collapse was greater than 50%. The preoperative regional deformity was measured at 23.2° (range 15–35°) which postoperatively reached 0.5° (range 20 to −17°). Conclusion: This technique for spinal shortening appears to be a better alternative to anterior reconstruction, especially when the vertebral collapse is greater than 50%. In this context, this
Purpose of the study: Balistic nerve injury is not common in civil medicine. We analyzed a series of 30 patients who underwent surgery for this type of injury suffered in the Gaza strip between 2002 and 2004. All patients presented paralysis of the sciatic nerve or one of its major branches. All injuries were caused by war weapons. Material and methods: The series included 28 men and two women, mean age 22 years (range 2.5–65). The injury had occurred more than one year earlier for 33% of patients. The injury was situated at the knee level in twelve patients and in the thigh in ten. Complete nerve section was observed in 12 patients and partial section in two. Loss of nervous tissue was significantly greater for lesions around the knee. Nineteen patients underwent surgery for: neurolysis (n=3), direct nerve suture (n=8) and nerve grafts (n=8). Eleven patients were reviewed at mean 13.7 months (range 3–30 months). There were no failures. Results of reinnervation of the tibial nerve territory were better than for the fibular nerve. Sixteen patients underwent palliative transfer for a hanging foot for more than six months: 15 transfers of the posterior tibial muscle through the interosseous membrane and hemitransfer of the Achilles tendon. Seven patients underwent Achilles tendon lengthening at the same time and five had a reinnervation procedure on the common fibular nerve. Results: Seven patients were reviewed with a mean follow-up of 1.8 years (range 4–30 months. None of the patients used an anti-equin orthesis. There were three cases of forefoot malposition. The overall Stanmore score was good at 75.4/100 (range 59–100). Discussion: High-energy ballistic trauma creates a specific type of injury. Nervous surgery can be indication early to favor spontaneous recovery.
We report the case of an 80-year-old woman treated by palliative knee arthrodesis for metastases of the proximal left tibia secondary to bladder carcinoma, using percutaneous femortibial intramedullary arthrodesis nailing. The technique provided a simple alternative to massive allografting, total joint prosthesis or amputation, with advantages of low morbidity, short operating time, minimal blood loss, immediate ambulation and weight bearing, relief of pain, restoration of independence, and ease of nursing care. We are satisfied with the procedure of percutaneous femorotibial intramedullary nailing as a palliative treatment of proximal tibial metastases in an elderly patient.
We report the case of an eight-month-old girl who presented with a poliomyelitis-like paralysis in her left upper limb caused by enterovirus 71 infection. She recovered useful function after nerve transfers performed six months after the onset of paralysis. Early neurotisation can be used successfully in the treatment of poliomyelitis-like paralysis in children.
The aim of this study was to assess the significance of the extent and adequacy of the surgical margin on three outcome variables; survival, metastasis and local recurrence. We statistically analysed (Cox proportional hazards regression modelling) 279 consecutive patients who presented with soft tissue sarcoma without meta-static disease. They were treated by a single surgeon to a standard protocol in two centres. In terms of overall survival, the failure to achieve a wide surgical margin by contaminating the resection, led to an elevenfold increase in the relative death rate (p=0.04). However, where the margin was not contaminated (even if the margin was closer than 1 mm) then the overall survival rate was similar across all groups of patients with a clear margin up to 20 mm. A large margin greater than 20mm afforded the lowest risk to overall survival. The extent of the surgical margin was not statistically significant in the development of metastatic disease. The presence of a contaminated surgical margin and a narrow margin less than 1mm led to a significantly higher rate of local recurrence (p=0.02) A margin greater than 1 mm allowed a satisfactory outcome in terms of a low local recurrence rate and the extent of the margin up to 20mm was not statistically important. Patients who had radical resections did poorly and generally represent a group where