Desenlaces funcionales y oncológicos en pacientes con lesiones metastásicas únicas óseas llevados a metastasectomía
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Date
2025
Authors
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Journal ISSN
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Publisher
Clinical Orthopaedics and Related Research (CORR)
Abstract
Introduction:
Solitary bone metastases represent a major clinical challenge. Surgical metastasectomy remains a valid option in selected patients. This study evaluated the oncologic and functional outcomes following metastasectomy in a cancer referral center in Bogotá, Colombia.
Methods:
A retrospective observational study including patients with solitary bone metastases who underwent metastasectomy between January 2004 and March 2024. Demographic, clinical, and surgical data were collected. Postoperative functionality was assessed using the MSTS score. Local recurrence, disease progression, and survival were analyzed with a minimum follow-up of 12 months. Kaplan–Meier and log-rank tests were used when appropriate.
Results:
Thirty patients (73.3% female) were included, with a mean age of 60.4 ± 10.9 years. The most common primary tumors were renal (26.7%) and breast (16.7%). The predominant surgical technique was endoprosthetic reconstruction (50%). Postoperative complications occurred in 40% (12/30), mainly infections (41%). Among 13 patients with recorded functionality, the moderate MSTS category was most common (53.8%), with no significant associations found with the evaluated clinical or surgical variables (all p > 0.10). During follow-up, 19 patients (63%) developed metastatic progression, 2 (6.7%) developed local recurrence, and 11 (36.6%) remained progression-free. The overall survival rate at 12 months was 65%, with a median follow-up of 12 months.
Conclusion:
Metastasectomy in patients with solitary bone metastases is a safe and effective procedure, yielding good functional outcomes and acceptable rates of disease progression and mortality. Its inclusion in multidisciplinary management should be considered in appropriately selected patients.
Description
Solitary bone metastases account for approximately 11% to 47% of all metastatic lesions; among these, around 70% involve the axial skeleton and nearly 10% the appendicular skeleton (1). The most frequent locations include the spine (65%), pelvis (34%), long bones (26%), and other sites (17%), a pattern explained by the anatomy of Batson’s venous plexus (2). Bone progression significantly worsens quality of life and oncologic prognosis, as it is associated with pain, functional limitation, pathological fractures, and spinal cord compression, among other complications (3). Indeed, skeletal-related events can occur in up to 70% of cases with bone progression, negatively impacting quality of life (4).
It has been reported that patients with solitary bone lesions, without visceral or brain metastases, and with the primary tumor resected or controlled, have a better prognosis (1). In this context, aggressive local treatment may be indicated even when the overall prognosis is limited, since optimal local control is associated with a potential curative benefit (5). Although the literature supports metastasectomy for solitary bone lesions from thyroid or renal carcinomas, there is limited evidence regarding the indication for wide resections in other neoplasms with solitary bone involvement. Nevertheless, it is considered that adequate and wide surgical resection, defined through multidisciplinary consensus and supported by current reconstructive techniques, could translate into improved survival and clinically meaningful functional recovery (6).
Therefore, gaps remain in the current evidence regarding functional and oncologic outcomes of metastasectomy in patients with solitary bone lesions, regardless of the primary cancer type. This study aims to provide high-quality data to determine the impact of metastasectomy on quality of life, survival, and local control, and to identify subgroups of patients who may particularly benefit from this surgical approach.
Keywords
Neoplasm Metastasis, Bone and Bones, Metastasectomy