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· DOS Abstracts
Epidemiology in surgical treatment of metastatic
bone disease of the appendicular skeleton -Reporting
from a consecutive prospective population based cohort.
Michala Skovlund Sørensen, Klaus Hindsø, Anders Troelsen, Stig Dalsgaard,
Tobias Fog, Tomasz Zimnicki, Michael Mørk Petersen
Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet,
University of Copenhagen; Pediatric section, Department of Orthopedic Surgery,
Rigshospitalet, University of Copenhagen; Clinical Orthopedic Research Hvidovre,
Copenhagen University Hospital Hvidovre, Copenhagen; Department of Orthopedic
Surgery, Herlev University Hospital, Herlev; Department of Orthopedic Surgery,
Nordsjællands Hospital, Hillerød; Department of Orthopedic Surgery, Bispebjerg and
Frederiksberg University Hospital, Copenhagen; Musculoskeletal Tumor Section,
Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen
Background:
Cancer related skeletal events in need of surgical treatment (SEST) is a
devastating event for patients suffering from cancer. Epidemiological data and the inci-
dence rate is lacking in current literature.
Purpose / Aim of Study:
1) find the incidence and epidemiological composition of SEST
in the appendicular skeleton. 2) see if the general health status of the patient (HOP)
influences the referral pattern.
Materials and Methods:
A consecutive prospective population-based cohort in the
Capital Region of Denmark was systematically screened for metastatic lesions treated
surgically in the appendicular skeleton for a two-year period.
Findings / Results:
174 lesions were identified giving an incidence of 48.6 SEST/mil-
lion inhabitants/year. Twelve patients had more than one SEST during the period of
whom nine patients was treated for two lesions in same anesthesia. Ninety-nine surger-
ies (57%) were treated at a tertiary referral center (TRC). The 5 most common can-
cers causing the lesions were: Mamma (n=39), lung (n=31), renal cell (n=25), pros-
tate (n=24) and myeloma (n=19). Anatomical location of lesions was: 126 femur (97
hip), 29 humerus (16 proximal), 14 pelvis, and 5 others. Fractured lesions/impending
fractures =131/43. Surgical treatment was: no reconstruction (n=10), reconstruction
with prosthesis (n=94) and osteosynthesis (n=70). Mean Karnofsky score 7.39 (TRC
7,47, p=0.47). Mean ASA score was 2.60 (TRC 2.45, p=0.02). One-year survival was
44% (95%CI: 36%-53%). Patients being treated at a TRC one-year survival were 52%
(95%CI: 41%-63%) and outside 34 % (95%CI: 22%-47%), p<0.05. No biopsy perop-
erative n=61.
Conclusions:
Incidence of SEST was found. Surgical technique, anatomical location of
lesion and cancer causing the lesions were identified. HOP did influence the referral pat-
tern indicating a selection of patients to highly specialized surgery.
No conflicts of interest reported
3.