Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease

Luksanapruksa, Panya; Buchowski, Jacob M.; Tongsai, Sasima; Singhatanadgige, Weerasak; Jennings, Jack W.

doi:10.1136/neurintsurg-2017-013350

Cited by 47 publications

(31 citation statements)

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“…For the spinal metastasis of hyper-vascular tumors, such as renal cell, hepatocellular, and thyroid cancers, preoperative embolization is recommended. Previous studies have verified the effectiveness of preoperative embolization in reducing intraoperative bleeding in spinal metastasis surgeries [85][86][87]. Surgery should be performed within 24 hours following embolization to avoid the diminished effect of preoperative embolization [88].…”

Section: Postoperative Complications and Preventive Measuresmentioning

confidence: 99%

Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

et al. 2020

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Metastatic spinal tumors are common, and their rising incidence can be attributed to the expanding aging population and increased survival rates among cancer patients. The decision-making process in the treatment of spinal metastasis requires a multidisciplinary approach that includes medical and radiation oncology, surgery, and rehabilitation. Various decision-making systems have been proposed in the literature in order to estimate survival and suggest appropriate treatment options for patients experiencing spinal metastasis. However, recent advances in treatment modalities for spinal metastasis, such as stereotactic radiosurgery and minimally invasive surgical techniques, have reshaped clinical practices concerning patients with spinal metastasis, making a demand for further improvements on current decision-making systems. In this review, recent improvements in treatment modalities and the evolution of decision-making systems for metastatic spinal tumors are discussed.

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Section: Postoperative Complications and Preventive Measuresmentioning

confidence: 99%

Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

et al. 2020

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“…In the present study, we compared the IBL during surgery for spinal metastases in patients undergoing or not undergoing PE and drew a different conclusion from the authors of a previous meta-analysis (18). A reduction in IBL after embolization was only observed during surgery for spinal metastases of hypervascular tumors determined as such using angiographic evidence.…”

Section: Discussionmentioning

confidence: 86%

“…Thus, the role of PE for spinal metastases remains controversial. A meta-analysis, conducted by Luksanapruksa et al (18), included five studies conducted between 1993 and 2015. They concluded that PE could be useful in reducing IBL in surgery for spinal metastases of both renal cell carcinoma and mixed tumors.…”

Section: Introductionmentioning

confidence: 99%

Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis

et al. 2021

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BackgroundThe role of preoperative embolization (PE) in reducing intraoperative blood loss (IBL) during surgical treatment of spinal metastases remains controversial.MethodsA systematic search was conducted for retrospective studies and randomized controlled trials (RCTs) comparing the IBL between an embolization group (EG) and non-embolization group (NEG) for spinal metastases. IBL data of both groups were synthesized and analyzed for all tumor types, hypervascular tumor types, and non-hypervascular tumor types.ResultsIn total, 839 patients in 11 studies (one RCT and 10 retrospective studies) were included in the analysis. For all tumor types, the average IBL did not differ significantly between the EG and NEG in the RCT (P = 0.270), and there was no significant difference between the two groups in the retrospective studies (P = 0.05, standardized mean difference [SMD] = −0.51, 95% confidence interval [CI]: −1.03 to 0.00). For hypervascular tumors determined as such by consensus (n = 542), there was no significant difference between the two groups (P = 0.52, SMD = −0.25, 95% CI: −1.01 to 0.52). For those determined as such using angiographic evidence, the IBL was significantly lower in the EG than in the NEG group, in the RCT (P = 0.041) and in the retrospective studies (P = 0.004, SMD = −0.93, 95% CI: −1.55 to −.30). For IBL of non-hypervascular tumor types, both the retrospective study (P = 0.215) and RCT (P = 0.947) demonstrated no statistically significant differences in IBL between the groups.ConclusionsOnly tumors angiographically identified as hypervascular exhibited lower IBL upon PE in this study. Further exploration of non-invasive methods to identify the vascularity of tumors is warranted.

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“…[18] Bir meta-analize göre, hipervasküler spinal metastaz cerrahisinde ameliyat öncesi embolizasyon, ameliyat sırasındaki ortalama kan kaybını 1226 mL azaltarak anlamlı bir fark ortaya koymuştur. [19] Kato ve ark., tiroid karsinomlarına bağlı spinal metastazların ameliyat öncesi embolizasyon sonrası,…”

Section: Spinal Metastazların Cerrahi Tedavisiunclassified

Tiroid karsinomlarında kemik metastazlarına yaklaşım ve güncel tedaviler

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2019

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EPİDEMİYOLOJİTiroid karsinomları, yıllar içerisinde sıklığında artış görülen malignensiler arasında yer alır; 2030 yılına gelindiğinde, ABD'de kolorektal kanserin yerini alarak, en sık görülen 4. kanser hastalığının tiroid kanserleri olacağı öngörülmektedir. [2] Türkiye'de ise tiroid kanseri insidansı, erkeklerde 2,1/100.000, kadınlarda ise 8,8/100.000 olarak raporlanmıştır. [3] Tiroid karsinomlarının büyük çoğunluğu, diferansiye tiroid karsinomları (DTK) olarak kabul edilen papiller tiroid karsinomu (PTK) (%70-75) ve foliküler tiroid T iroid karsinomlarının kemik metastazlarının tedavileri karmaşıktır ve bunlar sıklıkla kötü prognoz ile ilişkilendirilmiş lezyonlardır. Yüzde 80-95 olarak raporlanan diferansiye tiroid karsinomlarının 10 yıllık sağkalım oranları, kemik metastazları eşlik ettiğinde %13-21 aralığına kadar düşebilmektedir. [1] Hastalarda şiddetli ağrı ve patolojik kırıklara yol açabilen bu lezyonların tedavilerinde cerrahi de önemli bir role sahiptir. Bu derlemede, tiroid karsinomlarının tanı ve tedavisindeki güncel yaklaşımlar ile cerrahi prosedürleri incelemek ve yazarların bu konudaki deneyimlerini paylaşmak istedik.Tiroid kanserine bağlı kemik metastazları, şiddetli ağrıya, spinal kord kompresyonuna ve patolojik kırıklara yol açabilen, kötü prognoz ile ilişkilendirilmiş lezyonlardır. Aksiyel iskelet başta olmak üzere pek çok bölgede sıklıkla osteolitik karakterde görülebilen bu tümörlerin görüntülemelerinde, son yıllarda tüm vücut bilgisayarlı tomografi ve manyetik rezonans yöntemleri öne çıkmıştır. Bisfosfonatlar ve denosumab gibi antirezorptif ilaçların iskelet ilişkili olayları azalttığı düşünülmektedir. Hastaların sadece üçte ikisi radyoaktif iyot ablasyonu tedavisine duyarlıdır ve %46'sı bu tedaviye tam yanıt vermektedir. Sorafenibin metastatik tiroid kanserlerinin tedavilerine onay alması ile birlikte, tirozin kinaz inhibitörleri de kemik lezyonlarının tedavisinde ön plana çıkmıştır. Cerrahi tedavide vertebroplasti ve sementoplasti gibi perkütan yöntemler yer alır. Spinal lezyonlarda cerrahi dekompresyon için uygun hastaların seçiminde NOMS Framework (nörolojik, onkolojik, mekanik, sistemik) kılavuzundan yararlanılabilir. Hipervasküler özellikte tümörler olmaları nedeniyle, cerrahi öncesi anjiyoembolizasyon önerilmektedir. Başka bölgede metastazı olmayan hastaların kemik lezyonları primer malign kemik tümörü gibi varsayılarak tedavi edildiğinde, sağkalımın ve fonksiyonel sonuç skorlarının arttığına dair veriler ortaya konmuştur.Anahtar sözcükler: tiroid karsinomu; sorafenib; anjiyoembolizasyon; endoprotez Bone metastases due to thyroid cancer, which cause debilitating pain, spinal cord compression, and pathologic fractures are lesions mostly with poor prognosis. Whole body computerized tomography and magnetic resonance gained prominence in recent years in the imaging of these lesions which may present in various locations including the axial spine. Anti-resorptive drugs such as bisphosphonates and denosumab have been thought to reduce the incidence of skeletal related events. Only two thirds...

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Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease

Abstract: PE can be effective in reducing IBL in spinal metastases surgery in both renal cell carcinoma and mixed primary tumor groups.

Cited by 47 publications

References 11 publications

Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis

Tiroid karsinomlarında kemik metastazlarına yaklaşım ve güncel tedaviler

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