Quality of Life, Physical Function Are Impaired Long After Surgery for Spinal Chondrosarcoma
- After median follow-up of 5 years, physical function and quality of life in a group of 14 patients who underwent surgery for spinal chondrosarcoma were significantly worse than the U.S. population averages
- All dimensions of quality of life measured by the EuroQol 5 Dimensions questionnaire were slightly to moderately affected: physical function, pain and mental health
- In a larger cohort of 33 patients, rates of complications within 90 days, readmission and reoperation were high: 55%, 42% and 39%, respectively
- Readmission, reoperation and local recurrence rates were significantly higher after intralesional or en bloc resection with positive margins than after en bloc resection with negative margins
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To date, studies of surgery for chondrosarcoma have focused on oncologic outcomes. Now that life expectancy has improved, survivor quality of life must also become an important consideration.
Based on a retrospective cohort study reported in the Global Spine Journal, Nuno Rui Paulino Pereira, MD, PhD, research fellow, and Joseph H. Schwab, MD, MS, chief of the Orthopaedic Spine Center at Massachusetts General Hospital and the Mass General Cancer Center, and colleagues provide guidance for counseling patients about what to expect from surgery for spinal chondrosarcoma.
The researchers identified 33 adults who underwent primary or secondary resection of a mobile spine chondrosarcoma at the Mass General Orthopaedic Oncology Service between 1984 and 2014. The median age at surgery was 48 (range, 24–66) and 61% of patients were men.
In February 2015, 20 patients were alive and had been followed for at least six months. They were invited to complete online questionnaires about their physical function and quality of life:
- Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function
- PROMIS Pain Intensity
- EuroQol 5 Dimensions (EQ5D), which assesses quality of life
- Oswestry Disability Index (ODI) for thoracolumbar lesions or Neck Disability Index (NDI) for cervical lesions
Fourteen patients completed all of the questionnaires. For the entire cohort of 33 patients, the researchers also analyzed complications, readmissions, reoperations, neurologic status and oncologic outcomes. The median clinical follow-up was two years for all 33 patients and five years for the 14 patients who answered questionnaires.
Compared with the U.S. general population, the patients had a significantly worse physical function (median t-score 43, P = .036), and significantly worse quality of life (median EQ5D score 0.70, P = .02). All three dimensions measured by the EQ5D were slightly to moderately affected: physical function, pain and mental health.
On the PROMIS questionnaire, the median pain score was comparable to that of the general population, while the NDI/ODI scores indicated mild to moderate disability.
These results can be extrapolated to the entire cohort because the 14 patients who completed the questionnaires did not differ from the other 19 patients in age, sex, type of resection, tumor grade, complications, readmissions or reoperations.
Eighteen patients (55%) developed a complication within 90 days, of whom 14 (42% of the entire cohort) had at least one major complication and 10 (30%) had at least one minor complication. The most common major complications were dural tear (n=4), respiratory failure (n=3) and deep wound infection (n=2).
Fourteen patients (42%) patients were readmitted after a median of 13 months, and four patients required at least three readmissions. Readmission was significantly more common after intralesional resection or en bloc resection with positive margins than after en bloc resection with negative margins (60% vs. 15%, P = .02).
Thirteen patients (39%) patients required reoperation, and the median number of reoperations was two (range, 1–8). The most common reasons were irrigation and debridement for an infection, resection of a recurrence and reinstrumentation. Like readmission, reoperation was significantly more common in patients who initially had positive margins (55% vs. 15%, P = .03).
Eleven patients had a neurologic deficit preoperatively, of whom six improved, two experienced neurologic decline and one had no change. For the other two patients, neurologic status could not be determined at follow-up.
Oncologic outcomes were comparable to those in previous studies. Local recurrence occurred in 12 of the 20 patients who had positive margins and none of those with negative margins (P = .002). Six patients (18%) developed metastases to the lung, distant bone, brain, soft tissue of the neck and/or periaortic region. After a median follow-up of seven years, 11 patients had died of the disease.
For context, orthopedic surgeons should know that the median EQ5D and ODI scores in this study (0.70 and 25) were worse than those in a multicenter study published in The Spine Journal of more than 5,000 U.S. patients who underwent surgery for degenerative spine conditions, including disc herniation, spondylolisthesis, stenosis, adjacent segment disease and disc collapse. One year after surgery in that study, the median EQ5D score was 0.82 and the ODI score was 18.
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