1047 Local Recurrence and Functional Outcomes After Metastatic Spinal Cord Compression Surgery
W Y Yoon, T C Lam- Surgery
Abstract
Aim
Metastatic Spinal Cord Compression (MSCC) is one of the most important complications of cancer. Surgical decompression is an important treatment for MSCC with proven benefits in overall survival, yet it is highly invasive and carries a significant morbidity and mortality risk. This study aims to review the outcome of MSCC decompression surgery, including local recurrence, overall survival, and post-operative ambulatory function.
Method
A retrospective review of data of 121 patients who underwent MSCC surgery at Lancashire Teaching Hospitals over 8 years and Blackpool Victoria Hospital over 5 years was performed. Competing risk regression analysis, log-rank test and multiple variable regression were used for the analysis of local recurrence, overall survival and post-operative ambulatory function at 3 months.
Results
The crude local recurrence risk was 9/121 (7.4%), and median time to recurrence was 94 days (range = 7-416 days). Previous radiotherapy to the MSCC site was strongly associated with higher local recurrence risk after MSCC surgery (SHR = 10.490, p = 0.000). Poor pre-operative ambulatory status (OR:12.347, p = 0.001) was associated with worse functional outcomes at 3rd month. Decompression surgery with instrumentation (OR = 0.186, p = 0.033), post-operative radiotherapy (OR = 0.143, p = 0.010) and higher post-operative radiotherapy dose (OR: 0.923, p = 0.006) were associated with better post-operative functional outcomes at 3rd month. The use of post-operative Systemic Anti-Cancer Therapy (HR = 0.346, p = 0.000) and haematological cancers (HR = 0.341, p = 0.006) predicted longer overall survival.
Conclusions
Our findings indicate previous irradiation to the MSCC site predicts local recurrence after MSCC surgery. Surgery with instrumentation and post-operative radiotherapy is important for the preservation of ambulatory function in the early post-operative period.