title: Outcome after Surgery for Metastases to the Pelvic Bone: A Single Institutional Experience.
abstract: BACKGROUND
  The pelvic bone is the most common site of bone metastases following the axial skeleton. Surgery on the pelvic bone is a demanding procedure. Few studies have been published on the surgical outcomes of metastasis to the pelvic bone with only small numbers of patients involved. This study sought to analyze the complications, local progression and survival after surgery for metastasis to the pelvic bone on a larger cohort of patients.
  
  
  METHODS
  We analyzed 83 patients who underwent surgery for metastases to the pelvic bone between the years 2000 and 2015. There were 41 men and 42 women with a mean age of 55 years. Possible factors that might be associated with complications, local progression and survival were investigated with regard to patient demographics and disease-related and treatment-related variables.
  
  
  RESULTS
  The overall complication rate was 16% (13/83). Advanced age (> 55 years,p= 0.034) and low preoperative serum albumin levels (≤ 39 g/L,p= 0.001) were associated with increased complication rates. In patients with periacetabular disease, the complication rate was higher in those who underwent total hip replacement arthroplasty (THR) than those who did not (p= 0.030). Local progression rate was 46% (37/83). The overall median time to local progression was 26 ± 14.3 months. The median time from local progression to death was 13 months (range, 0 to 81 months). The local progression-free survival was 52.6% ± 6.4% at 2 years and 36.4%± 7.6% at 5 years, respectively. Presence of skip lesions (p= 0.017) and presence of visceral metastasis (p= 0.027) were found to be significantly associated with local progression. The median survival of all patients was 24 months. The 2-year and 3-year survival rates were 52.5% ± 5.9% and 35.6% ± 6%, respectively. Metastasis from the kidney, breast, or thyroid or of hematolymphoid origin (p= 0.014), absence of visceral metastasis (p= 0.017) and higher preoperative serum albumin levels (p= 0.009) were associated with a prolonged survival.
  
  
  CONCLUSIONS
  Advanced age and low serum albumin levels were associated with high complication rates. Local progression after surgery for metastases to the pelvic bone was affected by the presence of skip lesions, not by surgical margins. Primary cancer type, serum albumin level and visceral metastasis influenced survival.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.; Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, India.
authors.forename: Chandra Kumar
authors.initials: CK
authors.lastname: Krishnan
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ilkyu
authors.initials: I
authors.lastname: Han
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Han-Soo
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000008:Abdominal Neoplasms / Q000556:secondary*; D000077:Acetabulum; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D016063:Blood Loss, Surgical; D001859:Bone Neoplasms / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D002648:Child; D018450:Disease Progression; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D000072662:Margins of Excision; D059146:Metastasectomy / Q000009:adverse effects*; D008875:Middle Aged; D010384:Pelvic Bones; D011183:Postoperative Complications / Q000209:etiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012709:Serum Albumin
keywords: Bone neoplasms; Disease progression; Neoplasm metastasis; Pelvic bones; Surgery