BACKGROUND: Cancer of the lower intestinal tract, although relatively common, rarely metastasizes to the skeleton. The treatment of metastatic bone disease due to colorectal cancer has thus been poorly described and treatment decisions are therefore difficult. The aim of this study was to describe the outcome of orthopedic surgery in patients with pathological fractures from colorectal cancer and investigate factors that correlate with patient survival, since it influences treatment decisions. METHODS: Retrospective review of data collected in a prospectively collected database. 36 patients (38 fractures) who underwent surgery between 2000 and 2019 for metastatic bone disease caused by colorectal cancer were included. RESULTS: Most metastases were localized in the axial skeleton and 33/36 patients already had visceral metastases. Patients with pathological fractures from colorectal cancer had poor prognosis, with only 5/36 surviving more than 1 year, median survival being 3 months. Patients presenting with a single skeletal metastasis had a superior overall survival (P≤0.001). Post-operative complications were common, noted in 11 patients, and the surgical failure rate was considerable. CONCLUSIONS: Although relatively rare, bone metastases should be suspected in patients with colorectal cancer presenting with signs and symptoms of spinal cord compression or skeletal pain. In this case, the presence of a solitary skeletal lesion is a favorable prognostic sign. Awareness for local complications after surgery should be high. 2021 Journal of Gastrointestinal Oncology. All rights reserved.
BACKGROUND: Cancer of the lower intestinal tract, although relatively common, rarely metastasizes to the skeleton. The treatment of metastatic bone disease due to colorectal cancer has thus been poorly described and treatment decisions are therefore difficult. The aim of this study was to describe the outcome of orthopedic surgery in patients with pathological fractures from colorectal cancer and investigate factors that correlate with patient survival, since it influences treatment decisions. METHODS: Retrospective review of data collected in a prospectively collected database. 36 patients (38 fractures) who underwent surgery between 2000 and 2019 for metastatic bone disease caused by colorectal cancer were included. RESULTS: Most metastases were localized in the axial skeleton and 33/36 patients already had visceral metastases. Patients with pathological fractures from colorectal cancer had poor prognosis, with only 5/36 surviving more than 1 year, median survival being 3 months. Patients presenting with a single skeletal metastasis had a superior overall survival (P≤0.001). Post-operative complications were common, noted in 11 patients, and the surgical failure rate was considerable. CONCLUSIONS: Although relatively rare, bone metastases should be suspected in patients with colorectal cancer presenting with signs and symptoms of spinal cord compression or skeletal pain. In this case, the presence of a solitary skeletal lesion is a favorable prognostic sign. Awareness for local complications after surgery should be high. 2021 Journal of Gastrointestinal Oncology. All rights reserved.
Entities:
Keywords:
Colorectal cancer (CRC); bone metastases; pathological fracture
Authors: Rikard Wedin; Bjarne H Hansen; Minna Laitinen; Clement Trovik; Olga Zaikova; Peter Bergh; Anders Kalén; Gunnar Schwarz-Lausten; Fredrik Vult von Steyern; Anders Walloe; Johnny Keller; Rüdiger J Weiss Journal: J Shoulder Elbow Surg Date: 2011-10-07 Impact factor: 3.019
Authors: D Santini; M Tampellini; B Vincenzi; T Ibrahim; C Ortega; V Virzi; N Silvestris; R Berardi; C Masini; N Calipari; D Ottaviani; V Catalano; G Badalamenti; R Giannicola; F Fabbri; O Venditti; M E Fratto; C Mazzara; T P Latiano; F Bertolini; F Petrelli; A Ottone; C Caroti; L Salvatore; A Falcone; P Giordani; R Addeo; M Aglietta; S Cascinu; S Barni; E Maiello; G Tonini Journal: Ann Oncol Date: 2012-01-04 Impact factor: 32.976
Authors: F Ruatta; L Derosa; B Escudier; E Colomba; A Guida; G Baciarello; Y Loriot; K Fizazi; L Albiges Journal: Eur J Cancer Date: 2018-12-11 Impact factor: 9.162
Authors: Mark L Sundermeyer; Neal J Meropol; Andre Rogatko; Hao Wang; Steven J Cohen Journal: Clin Colorectal Cancer Date: 2005-07 Impact factor: 4.481
Authors: Matthew Steensma; Patrick J Boland; Carol D Morris; Edward Athanasian; John H Healey Journal: Clin Orthop Relat Res Date: 2011-08-31 Impact factor: 4.176