Ibrahim Ahmed, Crockard Alan, Antonietti Pierre, Boriani Stefano, Bünger Cody, Gasbarrini Alessandro, Grejs Anders, Harms Jürgen, Kawahara Norio, Mazel Christian, Melcher Robert, Tomita Katsuro
Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
J Neurosurg Spine. 2008 Mar;8(3):271-8. doi: 10.3171/SPI/2008/8/3/271.
Opinions vary widely as to the role of surgery (from none to wide margin excision) in the management of spinal metastases. In this study the authors set out to ascertain if surgery improves the quality of remaining life in patients with spinal metastatic and tumor-related systemic disease.
The authors included 223 patients in this study who were referred by oncologists and physicians over a 2-year period. All underwent surgery. Surgery was classified according to extent of excision ranging from en bloc excision or debulking to palliative surgery. All patients had a histologically confirmed diagnosis of epithelial spinal metastasis, and an oncology specialist undertook appropriately indicated adjuvant therapy in almost half of the patients.
The mean patient age was 61 years. Excisional en bloc or debulking surgery was performed in 74%; the rest had (minimal) palliative decompression. All patients considered for surgery were included in the study. Patients presented with pain in 92% of cases, paraparesis in 24%, and abnormal urinary sphincter function in 22% (5% were incontinent). Breast, renal, lung, and prostate accounted for 65% of the cancers, and in 60% of patients there were widespread spinal metastases (Tomita Type 6 or 7). The incidence of perioperative death (within 30 days of surgery) was 5.8%. Postoperatively 71% of the entire group had improved pain control, 53% regained or maintained their independent mobility, and 39% regained urinary sphincter function. The median survival for the cohort was 352 days (11.7 months); those who underwent excision survived significantly longer than those in the palliative group (p = 0.003). As with survival results, functional improvement outcome was better in those who underwent excision.
Surgical treatment was effective in improving quality of life by providing better pain control, enabling patients to regain or maintain mobility, and offering improved sphincter control. Although not a treatment of the systemic cancer, surgery is feasible, has acceptably low mortality and morbidity rates, and for many will improve the quality of their remaining life.
关于手术（从无手术到广泛边缘切除）在脊柱转移瘤治疗中的作用，观点差异很大。在本研究中，作者着手确定手术是否能改善脊柱转移瘤及肿瘤相关全身性疾病患者的剩余生活质量。
作者在本研究中纳入了223例患者，这些患者是在两年时间里由肿瘤学家和内科医生转诊而来的。所有患者均接受了手术。手术根据切除范围分类，从整块切除或减瘤手术到姑息性手术。所有患者均经组织学确诊为上皮性脊柱转移瘤，近一半患者由肿瘤专科医生进行了适当的辅助治疗。
患者的平均年龄为61岁。74%的患者接受了整块切除或减瘤手术；其余患者接受了（最小限度的）姑息性减压手术。所有考虑手术的患者均纳入研究。92%的患者出现疼痛，24%的患者出现轻瘫，22%的患者出现尿道括约肌功能异常（5%为尿失禁）。乳腺癌、肾癌、肺癌和前列腺癌占癌症的65%，60%的患者存在广泛的脊柱转移（Tomita 6型或7型）。围手术期死亡（手术30天内）发生率为5.8%。术后，整个组中71%的患者疼痛控制得到改善，53%的患者恢复或保持了独立活动能力，39%的患者恢复了尿道括约肌功能。该队列的中位生存期为352天（11.7个月）；接受切除手术的患者比姑息治疗组的患者存活时间显著更长（p = 0.003）。与生存结果一样，接受切除手术的患者功能改善结果更好。
手术治疗通过更好地控制疼痛、使患者恢复或保持活动能力以及改善括约肌控制，有效提高了生活质量。虽然手术并非全身性癌症的治疗方法，但它是可行的，死亡率和发病率低至可接受水平，并且对许多患者而言能改善其剩余生活质量。
