[Surgical treatment of skeletal metastases in the pelvis and extremities].

INTRODUCTION

In choosing a surgical treatment for skeletal metastases, an assessment of the individual patient's prognosis fis essential. The aim of surgical treatment is to alleviate pain and maintain function, thus improving the patient's quality of life. We analysed the survival of patients with skeletal metastases who had been surgically treated at the University Hospital in Aarhus from September 1999 to March 2003.

MATERIALS AND

METHODS

A consecutive series of 87 of 90 operations for non-spinal skeletal metastases was done. Three percent of the patients were operated on for more than one metastasis. Carcinomas of the breast, prostate, kidney and lung were the dominating primary tumors.

RESULTS

The survival rate was 0.35 at 1 year, 0.22 at 2 years and 0.14 at 3 years. Univariate analysis showed that survival was related to sex, bone localization, skeletal metastatic load, the presence of visceral metastases, Karnofsky performance score, primary tumor type, presence of a complete pathological fracture and preoperative haemoglobin content. Multivariate regression analysis showed that pathological fracture, haemoglobin content < 7 mmol/l and a poor Karnofsky score were negative prognostic factors for survival. Breast cancer was the sole independent positive prognostic factor for survival.

DISCUSSION: Most patients with two or three independent negative prognostic factors have an extremely short survival time, whereas patients with no negative prognostic factors may have a good prognosis. Surgical and reconstruction procedures should be chosen to minimise the risk of long-term failure in patients with a good prognosis and be as simple as possible in patients with a poor prognosis.