Highlights
- •There is an increased incidence of bone metastases due to improved of cancer patients survival.
- •“Oligometastases” represents a disease with metastatic localisations in a limited number (3 - 5) in the same body district.
- •Survival of oligometastatic patients is similar to patients with a single metastasis, requiring similar treatment.
- •Optimal implants survival curves should stay above the curves of patients survival.
- •Oligometastatic patients need to be treated with resection and reconstruction instead of using intralesional procedures such as nailing.
Abstract
Introduction
Long bone metastases are a disease of high social importance. The goals of surgical
treatment are to relieve pain, maintain or restore joint function, and prevent or
treat pathological fractures. “Oligometastases” is a disease with a limited number
(3–5) of metastatic lesions in the same body district, where an aggressive treatment
can be carried out with “curative” intent. This study aimed to evaluate patients with
bone metastases surgically treated to determine how surgical treatment can influence
prognosis and quality of life, comparing solitary metastasis, oligometastases, and
multiple metastases.
Patients and Methods
This is a retrospective analysis of 130 patients with long bone metastases surgically
treated between October 2015 and August 2019: 40 patients had solitary metastasis;
38 had less than three metastases (oligometastases), and 52 had multiple metastases.
Surgery was resection and reconstruction with a cemented prosthesis (95) or nailing
(35).
Results
Overall survival was significantly better in patients with solitary metastasis or
oligometastases than in those with multiple metastases (p <0.0001). Patients treated with resection and prosthesis had significantly better
survival than those treated with nailing (p <0.0001). Implant complications requiring surgical revision occurred in 20 patients
treated with prostheses, while no complications occurred in patients treated with
nailing.
Discussion
Survival of cancer patients has improved in the last two decades, leading to an increase
of diagnosed metastases. Patients with oligometastases have a survival similar to
those with a single metastasis. Optimal implants survival curves should stay above
the curves of patients survival.
Conclusions
Since there are no differences in survival, patients with oligometastases should be
treated as patients with a solitary lesion, with more aggressive surgery (wide resection
and reconstruction with prosthesis). Intramedullary nailing is still indicated in
metaphyseal or diaphyseal metastases in patients with advanced disease or poor prognosis
when the life expectancy does not overcome the expected survival of the nail, avoiding
the need for further surgery.
Keywords
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Article info
Publication history
Published online: November 10, 2020
Accepted:
November 10,
2020
Publication stage
In Press Journal Pre-ProofFootnotes
☆Each author certifies that the research has been performed following the ethical standards in the 1964 Declaration of Helsinki. Each author certifies that all patients or their relatives gave written informed consent to be included in scientific studies at hospital admission. Since this analysis is a retrospective review of our routine clinical practice with anonymised data, Research Ethics Committee Approval was not necessary for our Institution.
†This paper is part of a supplement supported by AOTrauma Italy.
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© 2020 Elsevier Ltd. All rights reserved.
