Abstract
ObjectiveTo investigate the impact of surgery on local control and quality of life for patients with sacral metastases and to determine whether the complications of surgery were acceptable.MethodsCurettage for metastatic lesions of the sacrum was performed in 154 patients with obvious sacral nerve compression symptoms between July 1997 and July 2014. Potential risk factors were evaluated in univariate analysis for associations with local control; multivariate conditional logistic regression was used to identify the combined effects. Complications were recorded. The pre- and postoperative visual analogue scale of pain, Eastern Cooperative Oncology Group (ECOG) scores, and quality of life scores were collected to evaluate the impact of surgery.ResultsThe cumulative survival rates were 71.8%, 41.1%, and 22.5% and the local control rates were 95.4%, 90.9%, and 79.4% at 6, 12, and 24 months, respectively. Tumors with rapid growth, the lack of preoperative radiotherapy, and application of aortic balloon occlusion were significantly associated with good local control. There were 29 (18.8%) complications related to surgery. The mean pain scores were 7.04 preoperatively, 1.66 at 1 month postoperatively (p = 0.003), and 1.51 at 3 months postoperatively (p = 0.002). The mean ECOG scores were 2.82 preoperatively and 1.47 3 months postoperatively (p < 0.001). There were significant improvements from preoperatively to 3 months postoperatively in global health status (43.3 vs. 52.1), pain (62.0 vs. 33.2), and constipation (51.4 vs. 30.3) (p < 0.001).ConclusionsSurgery for sacral metastasis is effective to palliate pain rapidly and improve constipation and quality of life and has a low rate of complications.
Highlights
The pre- and postoperative visual analogue scale of pain, Eastern Cooperative Oncology Group (ECOG) scores, and quality of life scores were collected to evaluate the impact of surgery
The lack of preoperative radiotherapy, and application of aortic balloon occlusion were significantly associated with good local control
Tumors of the sacrum are rare; including primary and metastatic lesions [1, 2], they account for 1–7% of all spinal tumors that come to clinical attention [3]
Summary
Tumors of the sacrum are rare; including primary and metastatic lesions [1, 2], they account for 1–7% of all spinal tumors that come to clinical attention [3]. With improved treatments for cancer, the number of patients with bony metastasis has increased and their survival time has lengthened [4]. Traditional conservative radiotherapy has long been the preferred first-line intervention for sacral metastasis. As the survival time of patients has lengthened, failure of local control has occurred in more patients who undergo traditional radiotherapy. In this situation, surgery could be considered as an important palliative approach for selected candidates with severe disease. Very few studies that included sufficient patient numbers and types of pathology have reported the results of surgical intervention for sacral metastasis [7, 8]. The effects and complications of surgery for sacral metastases remain unclear
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