Ishino Yuji, Kato Satoshi, Yokogawa Noriaki, Shimizu Takaki, Kawai Masafumi, Uto Takaaki, Nanpo Kazuhiro, Kawai Megumu, Demura Satoru
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan.
Cancers (Basel). 2024 Dec 10;16(24):4124. doi: 10.3390/cancers16244124.
Massive intraoperative blood loss (IBL) is one of the major complications in metastatic spinal tumor surgery (MSTS), and understanding the predictors of this risk is essential. This study aimed to determine the impact of the intratumoral flow void (IFV) observed on standard magnetic resonance imaging (MRI) and its association with IBL in palliative surgery for metastatic spinal tumors. This retrospective analysis included 88 palliative excisional surgeries performed at a single hospital between 2010 and 2024. Factors such as age, sex, body mass index, tumor location, histological tumor type, spinal instability neoplastic score, revised Tokuhashi score, preoperative radiation, presence of IFV, and IFV diameter were assessed in addition to surgical details such as the number of resected and instrumented vertebrae and surgical duration. Of the 88 patients, 71 (80.7%) exhibited IFV, with a mean IFV diameter of 1.8 ± 1.3 mm. The univariate analysis identified a significant association between IBL and several factors, including the presence of IFV, IFV diameter, hypervascular tumor type, number of instrumented vertebrae, and surgical duration. The multivariate analysis indicated that IFV diameter had the highest standardized coefficient among the examined variables, suggesting its strong potential as a predictor of IBL. This is the first study to identify the IFV diameter as a critical and independent predictor of IBL in MSTS. IFV diameter, which can be easily assessed using standard MRI, should be considered in surgical planning to effectively manage bleeding.
术中大量失血（IBL）是转移性脊柱肿瘤手术（MSTS）的主要并发症之一，了解这种风险的预测因素至关重要。本研究旨在确定在转移性脊柱肿瘤姑息手术中，标准磁共振成像（MRI）上观察到的瘤内血流空洞（IFV）的影响及其与IBL的关联。这项回顾性分析纳入了2010年至2024年在一家医院进行的88例姑息性切除手术。除了手术细节，如切除和固定的椎体数量以及手术持续时间外，还评估了年龄、性别、体重指数、肿瘤位置、组织学肿瘤类型、脊柱不稳定肿瘤评分、修订的Tokuhashi评分、术前放疗、IFV的存在以及IFV直径等因素。88例患者中，71例（80.7%）出现IFV，平均IFV直径为1.8±1.3mm。单因素分析确定了IBL与几个因素之间存在显著关联，包括IFV的存在、IFV直径、高血管肿瘤类型、固定椎体数量和手术持续时间。多因素分析表明，在检查的变量中，IFV直径具有最高的标准化系数，表明其作为IBL预测指标的强大潜力。这是第一项将IFV直径确定为MSTS中IBL关键且独立预测指标的研究。在手术规划中应考虑IFV直径，其可通过标准MRI轻松评估，以有效控制出血。
