Surgery for skeletal metastases in lung cancer

BACKGROUND AND PURPOSE Most lung cancer patients with skeletal metastases have a short survival and it is difficult to identify those patients who will benefit from palliative surgery. We report complication and survival rates in a consecutive series of lung cancer patients who were operated for symptomatic skeletal metastases. METHODS This study was based on data recorded in the Karolinska Skeletal Metastasis Register. The study period was 1987-2006. We identified 98 lung cancer patients (52 females). The median age at surgery was 62 (34-88) years. 78 lesions were located in the femur or spine. RESULTS The median survival time after surgery was 3 (0-127) months. The cumulative 12-month survival after surgery was 13% (95% CI: 6-20). There was a difference between the survival after spinal surgery (2 months) and after extremity surgery (4 months) (p = 0.03). Complete pathological fracture in non-spinal metastases (50 patients) was an independent negative predictor of survival (hazard ratio (HR) = 1.8, 95% CI: 1-3). 16 of 31 patients with spinal metastases experienced a considerable improvement in their neurological function after surgery. The overall complication rate was 20%, including a reoperation rate of 15%. INTERPRETATION Bone metastases and their subsequent surgical treatment in lung cancer patients are associated with high morbidity and mortality. Our findings will help to set appropriate expectations for these patients, their families, and surgeons.