Are older patients with solitary spinal metastases fit for total en-bloc surgery?
Are older patients with solitary spinal metastases fit for total en-bloc surgery?
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患有孤立性脊柱转移瘤的老年患者是否适合进行整块手术？
DOI：
10.1016/j.clineuro.2018.04.007
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发表时间：
2018-07-01
影响因子：
1.9
通讯作者：
Dong, Jian
中科院分区：
文献类型：
--
作者：
Liu, Peng;Jiang, Libo;Dong, Jian
目的：由于根治性切除，全脊椎切除(TES)与严重的手术损伤和脊柱不稳定有关，特别是在患有孤立性脊柱转移瘤(SM)的老年患者中，是否可能的好处大于风险需要认真考虑。我们的目的是比较和分析年龄对患者预后的影响。患者和方法：本研究调查了78例孤立性SM患者，分为A组(65岁，n=32)和B组(60岁，n=46)。根据手术前后的生存时间、局部复发、神经功能、疼痛和生活质量来评估手术结果。组间比较采用方差分析(ANOVA)或卡方检验。结果：两组在手术时间、出血量、输血量、住院天数等方面差异无统计学意义(p>；0.05)。此外，两组患者的中位生存时间差异无统计学意义(p>；0.05)。但A组围术期并发症发生率高于B组(p<；0.05)。两组患者的局部复发率比较差异无统计学意义(p>；0.05)，两组患者的神经功能、视觉模拟评分和Karnofsky评分的改善差异也无统计学意义(p>；0.05)。结论：老年患者的生存率和局部复发率与年轻患者相似。尽管老年患者围手术期并发症的风险增加，但这一因素似乎并不会导致严重的不良后果。经过精心的准备和严格的选择，高龄患者仍是接受TES治疗孤立性SM的良好人选。
Objective: Due to radical resection, total en-bloc spondylectomy (TES) is associated with significant levels of surgical injury and spinal instability, particularly in elderly patients with solitary spinal metastases (SM), whether the possible benefits outweigh the risk requires intense consideration. Our aim was to compare and analyze the impact of age on patient prognosis.Patients and Methods: This study investigated TES in 78 consecutive patients with solitary SM, who were divided into Group A ( > 65 years, n = 32) and group B ( < 60 years of age, n = 46). Surgical outcomes were assessed according to survival time, local recurrence, neurological function, pain, and quality of life before and after surgery. Differences between groups were statistically compared using analysis of variance (ANOVA) or chi-square tests.Results: There was no significant difference between the two groups in terms of surgery duration, blood loss, blood transfusion or the duration of hospital stay (p > 0.05). Furthermore, there was no significant difference in the median survival time between the two groups (p > 0.05). However, the perioperative complication rate in group A was higher than that in group B (p < 0.05). There was no significant difference in terms of local recurrence rate when compared between group A and group B (p > 0.05), and there were no significant differences in terms of improvements in neurological function, Visual Analogue Scale and Karnofsky scores of patients between the two groups (p > 0.05).Conclusion: Older patients can experience survival and local recurrence rates that were similar to those of younger patients. Although older patients are at increased risk of perioperative complications, this factor does not appear to lead to serious adverse outcomes. Older patients are still good candidates to receive TES to cure solitary SM after careful preparation and strict selection.