Medium to Long-Term Clinical Outcomes of Spinal Metastasectomy

SIMPLE SUMMARY: With the prolonged survival of metastatic cancer patients, medium to long-term outcomes of local therapy for oligometastases are important and should be discussed. Metastasectomy is a reasonable treatment for isolated lesions when feasible. This retrospective study aimed to examine the medium to long-term outcomes of spinal metastasectomy in 124 patients with isolated spinal metastases who underwent metastasectomy. The primary malignancy was renal cell carcinoma in 51 patients, thyroid carcinoma in 14 patients, low-grade sarcoma in 13 patients, lung cancer in 13 patients, breast cancer in 12 patients, and other malignancies in 21 patients. The 3-year and 5-year survival rates were 70% and 60%, respectively. Patients with thyroid cancer had the best survival results. The occurrence rates for the local recurrence of the operated spinal lesion and instrumentation failure were 10% and 22%, respectively. For certain patients with isolated and removable spine metastases, metastasectomy can be a useful treatment option. ABSTRACT: The prolonged survival of metastatic cancer patients highlights the importance of the local control of spinal metastases, which reduce patient performance status. This retrospective study examined the medium to long-term outcomes of spinal metastasectomy by evaluating 124 patients who underwent metastasectomy for isolated spinal metastases (2006–2018) with a postoperative follow-up for a minimum of 3 years. The findings present information on patient demographics (i.e., performance status, location of non-spinal metastases, and history of systemic therapy) and postoperative outcomes, including perioperative complications, disease progression of non-operated metastases, and additional excisional surgeries. Additionally, postoperative survival, local tumor control in the operated spine, and maintenance of spinal reconstruction without instrumentation failure were determined using Kaplan–Meier analyses. The primary malignancy was kidney and thyroid cancer in 51 and 14 patients, respectively, low-grade sarcoma and lung cancer in 13 patients, breast cancer in 12 patients, and other malignancies in 21 patients. The 3-year and 5-year survival rates were 70% and 60%, respectively. We found that patients with thyroid cancer had the best survival results, with local tumor recurrence and instrumentation failure at 10% and 22%, respectively. These findings suggest that for certain patients with isolated and removable spine metastases, metastasectomy can improve function and survival.