title: Survival and complications of skeletal reconstructions after surgical treatment of bony metastatic renal cell carcinoma.
abstract: Improvements in survival for patients with renal cell carcinoma have resulted in an increase in the burden of disease due to skeletal metastases, which are often solitary and resistant to radiotherapy. Surgical intervention remains a valid treatment to improve function and relieve pain, and replacement is able to achieve this and improve disease free implant survival. The aim of this study was identify prognostic factors for reconstruction survival of skeletal metastases in renal cell carcinoma and to characterise the nature of the reconstruction related complications. A retrospective analysis of all patients treated for metastatic renal cell carcinoma in three international bone tumour units between 2000 and 2014 identified 268 surgical interventions suitable for inclusion. Reconstruction survivorship was calculated using the Kaplan-Meier method whilst factors affecting reconstruction survival were assessed using Cox-regression multivariate analysis. Differences in proportions were assessed using Fisher's exact test. The overall rate of complications was 17%, which were classified as structural failure (7.1%), infection (4.9%) and tumour progression (3.7%). Endoprosthetic replacement when performed as the primary procedure demonstrate the best survivorship whilst factors associated with compromised reconstruction survival included previous surgical intervention and pre operative radiotherapy, and intralesional resection margins. We conclude that endoprosthetic replacement be considered as the index surgical intervention for skeletal metastases from renal cell carcinoma in certain locations as this carries the lowest incidence of complications. Revision of previous skeletal stabilisation, especially when combined with radiotherapy carries a high risk of complication, including infection, which often necessitates amputation.
authors.affiliation: Royal Orthopaedic Hospital, B31 2AP Birmingham, United Kingdom; Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, 33521 Tampere, Finland. Electronic address: minna.laitinen@nhs.net.
authors.forename: M
authors.initials: M
authors.lastname: Laitinen
authors.affiliation: Royal Orthopaedic Hospital, B31 2AP Birmingham, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Parry
authors.affiliation: Department of Hand Surgery, Helsinki University Central Hospital, 00260 Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Ratasvuori
authors.affiliation: Department of Orthopaedics, Karolinska University Hospital, 171 76 Stockholm, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Wedin
authors.affiliation: Royal Orthopaedic Hospital, B31 2AP Birmingham, United Kingdom; Hospital Italiano de Buenos Aires, 4190 Buenos Aires, Argentina.
authors.forename: J I
authors.initials: JI
authors.lastname: Albergo
authors.affiliation: Royal Orthopaedic Hospital, B31 2AP Birmingham, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Jeys
authors.affiliation: Royal Orthopaedic Hospital, B31 2AP Birmingham, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Abudu
authors.affiliation: Royal Orthopaedic Hospital, B31 2AP Birmingham, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Carter
authors.affiliation: Royal Orthopaedic Hospital, B31 2AP Birmingham, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Gaston
authors.affiliation: Royal Orthopaedic Hospital, B31 2AP Birmingham, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Tillman
authors.affiliation: Royal Orthopaedic Hospital, B31 2AP Birmingham, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Grimer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies
keywords: Complication; Implant survival; Reconstruction; Renal cell carcinoma; Skeletal metastases