Percutaneous Cementoplasty for the Pelvis in Bone Metastasis: 12-Year Experience

• Published in: Annals of surgical oncology 2022-02, Vol.29 (2), p.1413-1422
• Main Authors: Park, Jong Woong, Lim, Hyun-ju, Kang, Hyun Guy, Kim, June Hyuk, Kim, Han-Soo
• Format: Article
• Language: English
• Subjects: Anesthesia; Bone cancer; Bone Cements - therapeutic use; Bone implants; Bone Neoplasms - surgery; Bone tumors; Cement; Cementoplasty; Embolism; Embolisms; Gait; Humans; Injection; Malignancy; Medicine; Medicine & Public Health; Metastases; Metastasis; Movement disorders; Oncology; Pain; Pelvic Bones; Pelvis; Polymethylmethacrylate; Retrospective Studies; Sarcoma; Surgery; Surgical Oncology; Surgical outcomes; Thrombosis; Treatment Outcome
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-10640-8

Background In advanced cancer patients, pelvic bone metastasis often causes pain and gait disturbance. The use of percutaneous bone cement [polymethylmethacrylate (PMMA)] injection for pain management and strengthening in pelvic bone metastasis has rarely been reported. To evaluate this method, we aimed to determine surgical outcomes and complications over a long-term follow-up period using a large patient group. Patients and Methods We retrospectively collected data from 178 patients who underwent percutaneous cementoplasty for pelvic metastatic lesions, 201 in total. Surgical outcomes evaluated included pain reduction and improvement of ambulation. Mortality within 1 month after procedure and pulmonary embolism caused by thrombus, fat, tumor emboli, or bone cement were investigated as surgical complications. For long-term survivors, pain relapse and mechanical failure were analyzed. The mean follow-up period was 12.6 months, and there were 159 fatalities at last follow-up. Results The mean regional pain numerical rating scale scores decreased from 6.1 preoperatively to 2.4 1 month after procedure ( p < 0.01). Gait function was maintained, worsened, and uncheckable in 68%, 24%, and 8% of patients, respectively, 1 month after procedure. Of long-term survivors followed up for > 12 months ( n = 53), there were no significant changes in serial plain radiographs, and regional pain aggravation was observed in 9%. Pulmonary cement embolism and bone cement implantation syndrome was observed in 11% and 10%, respectively. However, all patients with these complications were asymptomatic. Conclusions Percutaneous cement injection into the pelvis is a feasible and safe palliative surgical option for patients with advanced malignancy in terms of pain reduction and maintenance of ambulatory function under regional anesthesia.