Outcomes of Surgical Decompression for Spinal Metastases From Gynecological Cancers: A Retrospective Cohort Study

Abstract

Background and Aim: Gynecological cancer is one of the most common types of cancer worldwide. Nonetheless, spinal metastasis from gynecological cancer is scarcely reported in the literature. In cases of spinal cord compression, the standard treatment is a decompressive surgery followed by radiotherapy treatment for selected patients. This study aimed to report the overall survival and surgical results in patients presenting with gynecological spinal metastases who underwent spinal cord/nerve root decompression and stabilization. Methods and Materials/Patients: A total of 18 patients were included in this study. The surgical procedures were performed from 2012 to 2019. The evaluation of neurological status, spinal stability, and pain were performed using the American Spinal Injury Association Impairment Scale (ASIA), Spinal Instability Neoplastic Score (SINS), and Visual Analogue Scale (VAS), respectively. Results: The lumbar spine was the most affected location (n=30; 50.0%). Regarding the preoperative neurological deficits, 16 cases (n=16; 88.9%) presented ASIA graded A–D before the surgery, being reduced to five (n=5; 27.8%) after the procedures. The pain level means (pre-and postoperative) were 9.39±0.79 and 2.28±1.44. The overall median survival was 6.1 months (95% Confidence Interval [CI] of 1.10–11.13 months). The mean survival of ambulatory and non-ambulatory patients before the surgery was 7.36 months and 3.2 months, respectively (P=0.007 – Log-rank Mantel–Cox). Conclusion: Decompressive surgery and stabilization promote mechanical pain relief, spinal stability, an improvement of neurological function, and indirectly improving quality of life, despite a dismal overall survival of patients who present with metastatic spinal compression disease.

Keywords

• female genital neoplasms
• neoplasm metastasis
• spinal cord compression
• epidural neoplasms