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A Discussion on the Criteria for Surgical Decision-Making in Elderly Patients With Metastatic Spinal Cord Compression

STUDY DESIGN: Retrospective study. OBJECTIVES: Although the role of surgery in the management of metastatic spinal cord compression (MSCC) has been well established, elderly patients may still be denied surgery because of higher risk of complications and shorter life expectancy. The purpose of this...

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Autores principales: Gao, Xin, Wu, Zheyu, Wang, Tao, Cao, Jiashi, Bai, Guangjian, Xin, Baoquan, Cao, Shuang, Jia, Qi, Liu, Tielong, Xiao, Jianru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837498/
https://www.ncbi.nlm.nih.gov/pubmed/33525916
http://dx.doi.org/10.1177/2192568221991107
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author Gao, Xin
Wu, Zheyu
Wang, Tao
Cao, Jiashi
Bai, Guangjian
Xin, Baoquan
Cao, Shuang
Jia, Qi
Liu, Tielong
Xiao, Jianru
author_facet Gao, Xin
Wu, Zheyu
Wang, Tao
Cao, Jiashi
Bai, Guangjian
Xin, Baoquan
Cao, Shuang
Jia, Qi
Liu, Tielong
Xiao, Jianru
author_sort Gao, Xin
collection PubMed
description STUDY DESIGN: Retrospective study. OBJECTIVES: Although the role of surgery in the management of metastatic spinal cord compression (MSCC) has been well established, elderly patients may still be denied surgery because of higher risk of complications and shorter life expectancy. The purpose of this study was to determine whether elderly patients with MSCC could benefit from surgery and discuss the criteria for surgical decision-making in such patients. METHODS: Enrolled in this study were 55 consecutive patients aged 75 years or older who were surgically treated for MSCC in our center. Prognostic factors predicting overall survival (OS) were explored by the Kaplan-Meier method and Cox regression model. The quality of life (QoL) of the patients was evaluated by the SOSGOQ and compared using Student’s t test. Risk factors for postoperative complications were identified by Chi-square test and multiple logistic regression analysis. RESULTS: Surgical treatment for MSCC substantially improved the neurological function in 55.8% patients and QoL in 88.5% patients with acceptable rates of postoperative complications (16.4%), reoperation (9.1%), and 30-day mortality (1.8%). Postoperative ECOG-PS of 1-2, total en-bloc spondylectomy (TES), and postoperative chemotherapy were favorable prognostic factors for OS, while a high Charlson Comorbidity Index (CCI) and a long operation time were risk factors for postoperative complications. CONCLUSIONS: Surgery should be encouraged for elderly patients with MSCC 1) who are compromised by the current or potential neurological dysfunction; 2) with radioresistant tumors; 3) with spinal instability; and 4) with no comorbidity, ECOG-PS of 0-2, and systemic treatment adherence. In addition, surgery should be performed by a skilled and experienced surgical team.
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spelling pubmed-98374982023-01-14 A Discussion on the Criteria for Surgical Decision-Making in Elderly Patients With Metastatic Spinal Cord Compression Gao, Xin Wu, Zheyu Wang, Tao Cao, Jiashi Bai, Guangjian Xin, Baoquan Cao, Shuang Jia, Qi Liu, Tielong Xiao, Jianru Global Spine J Original Articles STUDY DESIGN: Retrospective study. OBJECTIVES: Although the role of surgery in the management of metastatic spinal cord compression (MSCC) has been well established, elderly patients may still be denied surgery because of higher risk of complications and shorter life expectancy. The purpose of this study was to determine whether elderly patients with MSCC could benefit from surgery and discuss the criteria for surgical decision-making in such patients. METHODS: Enrolled in this study were 55 consecutive patients aged 75 years or older who were surgically treated for MSCC in our center. Prognostic factors predicting overall survival (OS) were explored by the Kaplan-Meier method and Cox regression model. The quality of life (QoL) of the patients was evaluated by the SOSGOQ and compared using Student’s t test. Risk factors for postoperative complications were identified by Chi-square test and multiple logistic regression analysis. RESULTS: Surgical treatment for MSCC substantially improved the neurological function in 55.8% patients and QoL in 88.5% patients with acceptable rates of postoperative complications (16.4%), reoperation (9.1%), and 30-day mortality (1.8%). Postoperative ECOG-PS of 1-2, total en-bloc spondylectomy (TES), and postoperative chemotherapy were favorable prognostic factors for OS, while a high Charlson Comorbidity Index (CCI) and a long operation time were risk factors for postoperative complications. CONCLUSIONS: Surgery should be encouraged for elderly patients with MSCC 1) who are compromised by the current or potential neurological dysfunction; 2) with radioresistant tumors; 3) with spinal instability; and 4) with no comorbidity, ECOG-PS of 0-2, and systemic treatment adherence. In addition, surgery should be performed by a skilled and experienced surgical team. SAGE Publications 2021-02-02 2023-01 /pmc/articles/PMC9837498/ /pubmed/33525916 http://dx.doi.org/10.1177/2192568221991107 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Gao, Xin
Wu, Zheyu
Wang, Tao
Cao, Jiashi
Bai, Guangjian
Xin, Baoquan
Cao, Shuang
Jia, Qi
Liu, Tielong
Xiao, Jianru
A Discussion on the Criteria for Surgical Decision-Making in Elderly Patients With Metastatic Spinal Cord Compression
title A Discussion on the Criteria for Surgical Decision-Making in Elderly Patients With Metastatic Spinal Cord Compression
title_full A Discussion on the Criteria for Surgical Decision-Making in Elderly Patients With Metastatic Spinal Cord Compression
title_fullStr A Discussion on the Criteria for Surgical Decision-Making in Elderly Patients With Metastatic Spinal Cord Compression
title_full_unstemmed A Discussion on the Criteria for Surgical Decision-Making in Elderly Patients With Metastatic Spinal Cord Compression
title_short A Discussion on the Criteria for Surgical Decision-Making in Elderly Patients With Metastatic Spinal Cord Compression
title_sort discussion on the criteria for surgical decision-making in elderly patients with metastatic spinal cord compression
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837498/
https://www.ncbi.nlm.nih.gov/pubmed/33525916
http://dx.doi.org/10.1177/2192568221991107
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