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Taha MM, Taha MM, Ezzat M, Abouhashem S. Evolving metastasis in patients with chronic viral hepatitis as a cause of sciatic pain; pitfalls in diagnosis and management. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Goodwin CR, Yanamadala V, Ruiz-Valls A, Abu-Bonsrah N, Shankar G, Sankey EW, Boone C, Clarke MJ, Bilsky M, Laufer I, Fisher C, Shin JH, Sciubba DM. A Systematic Review of Metastatic Hepatocellular Carcinoma to the Spine. World Neurosurg 2016; 91:510-517.e4. [PMID: 27090971 PMCID: PMC5586495 DOI: 10.1016/j.wneu.2016.04.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) frequently metastasizes to the spine. The impact of medical and/or surgical intervention on overall survival has been examined in a limited number of clinical studies, and herein we systematically review these data. METHODS We performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles that reported survival, clinical outcomes, and/or prognostic factors associated with patients diagnosed with spinal metastases. The methodologic quality of each review was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses tool. RESULTS There were 26 articles (152 patients) that met the inclusion criteria and were treated with either surgery, radiotherapy, chemotherapy, and/or observation. There were 3 retrospective cohort studies, 17 case reports, 5 case series, and 1 longitudinal observational study. Of the patients with known overall survival after diagnosis of spinal metastasis, survival at 3 months, 6 months, 1 year, 2 years, and 5 years was 95.2%, 83.0%, 28.6%, 2.0%, and 1.4%, respectively. The median survival after diagnosis of the metastasis was 0.7 months in the patients who received no treatment, 7 months in the patients treated with surgical intervention alone, 6 months for patients who received chemotherapy and/or radiation, and 13.5 months in the patients treated with a combination of surgery and medical management. All other clinical or prognostic parameters were of low or insufficient strength. CONCLUSIONS Patients diagnosed with HCC spinal metastasis have a 10.6-month overall survival. Further analysis of patients in prospective controlled trials will be essential to the development of treatment algorithms for these patients in the future.
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Affiliation(s)
- C. Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vijay Yanamadala
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Alejandro Ruiz-Valls
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ganesh Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Eric W. Sankey
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine Boone
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Mark Bilsky
- Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Ilya Laufer
- Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Charles Fisher
- Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ji T, Eskander R, Wang Y, Sun K, Hoang BH, Guo W. Can surgical management of bone metastases improve quality of life among women with gynecologic cancer? World J Surg Oncol 2014; 12:250. [PMID: 25091036 PMCID: PMC4125343 DOI: 10.1186/1477-7819-12-250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/20/2014] [Indexed: 11/11/2022] Open
Abstract
Background The evaluation, counseling, and management of gynecologic patients with bone metastasis remain a challenge for clinicians. In order to critically evaluate the role of surgery, we retrospectively analyzed the records of 18 patients surgically treated for metastatic gynecologic tumors of bone, focusing on quality of life, local tumor control, and survival. Methods Eighteen patients underwent surgical procedures for the treatment of bone metastases secondary to gynecologic cancer between September 2003 and April 2012. The primary cancer sites included the uterus (n = 10), the cervix (n = 5), and an ovary (n = 3). Patients were followed for an average period of 13.8 months (range, 2 to 34 months). A visual analog pain scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status were evaluated both pre- and postoperatively. Results The median survival time following diagnosis of bone metastasis was 10.0 months. The mean VAS score was 5.8 preoperatively compared with 2.1, 3 months after surgery. The mean pre and postoperative ECOG performance status grades were 3.1 and 2.3, respectively. Conclusions The prognosis of gynecological cancer patients with bone metastasis is poor. Some patients had improvement in their quality of life after surgical intervention for bone metastases; however, novel integrated treatment modalities should be investigated.
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Affiliation(s)
| | | | | | | | | | - Wei Guo
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China.
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Outcomes after surgery for spinal metastasis of colorectal origin: case series. Asian Spine J 2014; 8:267-72. [PMID: 24967040 PMCID: PMC4068846 DOI: 10.4184/asj.2014.8.3.267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/31/2013] [Accepted: 04/02/2013] [Indexed: 11/26/2022] Open
Abstract
Study Design Retrospective study. Purpose The aim of this study was to evaluate the clinical management and outcomes of patients who underwent surgical intervention for metastatic colorectal adenocarcinoma of the spine. Overview of Literature Gastrointestinal (GI) cancer metastasis to the spine are relatively rare and represent later manifestations of the disease. Studies and reports on the outcomes of patients who undergo surgery for spinal metastasis of GI origin are scarce. Methods A retrospective chart review of all patients who underwent surgery for spinal metastasis of colorectal origin was performed. Four patients were identified. Patient characteristics, outcomes, and survival were analyzed. Results Two patients experienced improvement in pain or myelopathic symptoms. Although the mean survival was 15.3 months, this average included a patient still living at 57.1 months. The mean survival was just 1.3 months for the 3 patients who expired. Conclusions In certain cases, symptomatic improvement with prolonged survival is possible after surgery for metastatic spinal lesions of colorectal origin; however, survival is poor in the majority of cases.
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Kim CH, Chung CK, Jahng TA, Kim HJ. Surgical outcome of spinal hepatocellular carcinoma metastases. Neurosurgery 2012; 68:888-96. [PMID: 21221023 DOI: 10.1227/neu.0b013e3182098c18] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Spinal hepatocellular carcinoma (HCC) metastases are increasing with improved survival of patients with HCC. However, its treatment outcome, particularly regarding functional outcome, has not been adequately investigated. OBJECTIVE To present the surgical outcome of spinal HCC metastases and demonstrate prognostic factors for survival and ambulation time. METHODS Thirty-three patients (30 males, 3 females) were retrospectively reviewed. Child-Pugh classification was used to assess hepatic function. Preoperatively, 19 patients could ambulate (group A) and 14 patients could not (group B). Preoperatively, 18 patients received conventional fractionated radiotherapy. RESULTS The spinal metastases were removed to achieve sufficient neural decompression. If destabilization developed, instrumentation and/or vertebroplasty were performed. Postoperatively, conventional radiotherapy was administered to 13 patients. Patients survived for 203 ± 31 days. Child-Pugh classification and preoperative/postoperative ambulatory ability were correlated with survival time, with Child-Pugh classification being the most significant factor (hazard ratio, 3.75; 95% confidence interval: 1.38-10.22). After the operation, ambulatory ability was maintained in all group A patients and was recovered in 4 in group B. Twenty-three patients could ambulate for 285 ± 62 days. Preoperative ambulatory status and Child-Pugh classification were correlated with a longer ambulatory period, with preoperative ambulatory status most significant (hazard ratio, 8.62; 95% confidence interval: 2.39-31.04). Patients died 81 ± 71 days after the loss of ambulatory ability, regardless of postoperative ambulatory status. CONCLUSION In spinal HCC metastasis, ambulatory status and hepatic function were significantly correlated with survival and ambulation time. Both ambulatory status and hepatic function should be considered in the selection of surgical candidates.
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Affiliation(s)
- Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea
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Tang X, Guo W, Yang R, Tang S, Dong S. Use of aortic balloon occlusion to decrease blood loss during sacral tumor resection. J Bone Joint Surg Am 2010; 92:1747-53. [PMID: 20660238 DOI: 10.2106/jbjs.i.01333] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aortic balloon occlusion has been introduced into sacral tumor surgery to reduce extensive hemorrhage. The purposes of this retrospective study were to determine the efficacy of aortic balloon occlusion in decreasing intraoperative and postoperative blood losses and to analyze the complications of this technique. METHODS The cases of 215 patients in whom a sacral tumor had been treated surgically between 1997 and 2009 were studied retrospectively. Ninety-five patients who had had sacral tumor resection without aortic balloon occlusion were compared with 120 patients in whom aortic balloon occlusion had been carried out during the tumor resection. The demographic data, possible factors influencing hemorrhage, and total blood loss volume (including intraoperative and postoperative volumes) were determined with a review of the medical records and compared between the two groups. RESULTS There were no significant differences between the two groups in terms of the demographic data, grade of malignancy, tumor blood supply, location of the tumor, percentage of patients who had a recurrent tumor or preoperative radiation, surgical approach, or type of resection. The patients with aortic balloon occlusion had a larger mean tumor volume, more frequently had a sacral reconstruction, and had a longer mean operative time; however, their mean total (2963 mL) and intraoperative (2236 mL) blood loss volumes were lower than those of the patients without occlusion (4337 and 3935 mL, respectively) (p < 0.001). Complications related to aortic balloon occlusion included femoral artery embolism in three patients and hematoma formation at the puncture site in five. CONCLUSIONS Aortic balloon occlusion decreases the total and intraoperative blood loss volumes in patients treated with sacral tumor surgery who require extensive dissection. There is a low rate of balloon-related complications.
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Affiliation(s)
- Xiaodong Tang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China
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Chan KM, Yu MC, Wu TJ, Lee CF, Chen TC, Lee WC, Chen MF. Efficacy of surgical resection in management of isolated extrahepatic metastases of hepatocellular carcinoma. World J Gastroenterol 2009; 15:5481-8. [PMID: 19916180 PMCID: PMC2778106 DOI: 10.3748/wjg.15.5481] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To clarify the benefit of surgical excision for patients with extrahepatic metastases of hepatocellular carcinoma (HCC).
METHODS: We retrospectively reviewed the medical records of 140 patients with pathologically proven extrahepatic metastases of HCC and evaluated the outcomes of those who had undergone surgical resection (SR) for extrahepatic metastatic lesions. Prognoses made on the basis of extrahepatic metastatic sites were also examined.
RESULTS: The survival rates of patients who underwent SR of extrahepatic metastases were significantly better than those of patients who did not receive SR. For the SR group, 1- and 3-year survival rates were 24% and 7%, respectively, while for the non-resection group, the survival rates were 8% and 0%, respectively (P < 0.0001). Survival rates related to metastatic sites were also significantly superior after SR of extrahepatic metastases: median survivals were 32 mo with lung metastasis, 10 mo with bone metastasis, 6.1 mo with brain metastasis.
CONCLUSION: SR can provide survival benefits for patients with 1 or 2 isolated extrahepatic metastases and who concurrently exhibit good hepatic functional reserve and general performance status as well as successful treatment of intrahepatic HCC.
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Tang X, Guo W, Yang R, Tang S, Ji T. Risk factors for blood loss during sacral tumor resection. Clin Orthop Relat Res 2009; 467:1599-604. [PMID: 18781369 PMCID: PMC2674153 DOI: 10.1007/s11999-008-0483-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 08/15/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Extensive hemorrhage is a serious complication during sacral tumor resection. Identifying the risk factors predicting the possibility of extensive hemorrhage would be important to predict which patients would need large amounts of transfused blood intraoperatively and postoperatively and which patients would need blood control by vascular occlusion. We retrospectively reviewed 173 patients who underwent sacral tumor resection performed at our institute between 2003 and 2007. Patients with an estimated total blood loss greater than 3000 mL were classified as having a large amount of blood loss. Sixty-nine (39.88%) patients had blood loss greater than 3000 mL. Male gender, excessive tumor blood supply, tumors involving the S2 body and cephalad to the S2 body, tumor volume greater than 200 cm(3), aorta occlusion, surgical approach, reconstruction, and operative time were associated with a large amount of blood loss. Tumors cephalad to the S2-S3 disc space (odds ratio, 3.840), tumor volume greater than 200 cm(3) (odds ratio, 3.381), and excessive blood supply (odds ratio, 2.281) independently predicted a large amount of blood loss. Sacral tumors that invaded cephalad to the S2-S3 disc space with a volume greater than 200 cm(3) and an excessive blood supply were likely to have a large amount of blood loss during resection. LEVEL OF EVIDENCE Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Xiaodong Tang
- Musculoskeletal Tumor Center, People’s Hospital, Peking University, Beijing, 100044 China
| | - Wei Guo
- Musculoskeletal Tumor Center, People’s Hospital, Peking University, Beijing, 100044 China
| | - Rongli Yang
- Musculoskeletal Tumor Center, People’s Hospital, Peking University, Beijing, 100044 China
| | - Shun Tang
- Musculoskeletal Tumor Center, People’s Hospital, Peking University, Beijing, 100044 China
| | - Tao Ji
- Musculoskeletal Tumor Center, People’s Hospital, Peking University, Beijing, 100044 China
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