The 'choice' of surgery for cancer combined with bone metastasis is difficult for doctors! It needs a continuous assessment of the pros and cons for patients!
by PQ WuIn the previous article, we described the surgical indications of cancer combined with bone metastasis, which include the bone-metastatic pain that cannot be controlled by medication and radiation therapy, a close to or already occurred pathological fracture, compression to the spinal nerves by bone-metastatic tumors, the expectation of a relatively good prognosis of primary cancer, or solitary bone metastasis. After knowing when surgery is needed, let's talk about how to do it.
There are quite a few methods of surgery. To understand which way is best, we must first know the purpose of the surgery. In general, the objectives of surgery for cancer combined with bone metastasis are two broad directions:
First. Hope to cure cancer. The purpose of the surgery is to 'completely remove' bone tumors that metastasized to the bone to avoid recurrence and reconstruct the patient's limb function. This purpose applies to patients who are expected to recover well from primary cancer or have only a solitary bone metastasis.
Second. Purely improve patient’s quality of life. The purpose of surgery is to relieve the patient's pain, avoid pathological fractures, and maintain the physical function of the patient's basic daily life. This purpose applies to patients who have bone-metastatic pains that cannot be controlled by medication and radiation therapy, patients on the verge of or have pathological fractures, and patients with bone-metastatic tumors that compress the spinal nerves.
Based on the two different purposes, we do our surgeries in completely different ways!
The removal of tumor surgery can be divided into two categories. The first is 'wide resection,’ and the second is 'intralesional curettage.’ "Wide resection" refers to the complete removal of a tumor with a whole section of the bone. "Intralesional curettage” is to preserve the original bone and scrape only the tumor inside. Let's take a look at the figures for more clarity:
The difference between wide resection and intralesional curettage
Higher risk
Longer operation time
Lower risk
Shorter operation time
Larger surgery range
Slower recovery
Smaller surgery range
Faster recovery
Post-operative radiation therapy not required
Lower recurrence rate
Post-operative radiation therapy is required
Higher recurrence rate
From the above descriptions, we can clearly understand the different characteristics of the two surgeries. Hence, we can choose the way of surgery in line with its features and purpose. We can put it into two sentences:
Wide resection is the use of 'big damage,' 'big reconstruction' to completely cure the tumor.
by PQ WuIntralesional curettage uses 'small damage,' 'small reconstruction' to quickly reduce pain and avoid or treat fractures.
by PQ Wu
If the patient's overall prognosis is better, we should see it as a 'primary malignant osteosarcoma' when treating the bone metastasized tumor and hope to cure it. Therefore, the surgical method will be more complex, which is wide resection. Artificial joints or biological bones can reconstruct the bone defects after tumor removal. For detailed descriptions, you can read our articles below.
Since wide resection takes a higher surgical risk and longer recovery time, not most patients with cancer combining bone metastasis are suitable. Therefore, if the patients are not matched the descriptions above, we will recommend intralesional curettage.
The overall surgical time of intralesional curettage is fast, the risk is relatively low, and the recovery can be much rapid. It is a safer and more effective method for most cancer patients with bone metastasis. To reduce the recurrence rate after surgery, we can provide adjuvant therapy depending on the patients' condition, such as phenol combined with alcohol, liquid nitrogen cryotherapy, or FNEC cryotherapy. For detailed descriptions, you can read our articles below.
Under appropriate circumstances, proper surgery can bring great benefits to patients with cancer combined with bone metastasis. The benefits include improvement of quality of life and the treatment control of diseases. But what most important and needed to reemphasize is that since cancer patients are in poorer health than the general public, the overall risk of surgery and anesthesia is greatly increased! Before surgery, physician teams will complete the comprehensive assessment. Patients and family members must also communicate, discuss, and understand the surgeon's dilemma between conducting the operation to reduce the patient’s pain and a regretful outcome that no one wants to see!). With the premise of a mutual understanding, the physicians can keep their faith to help patients!