Introduction: Despite advancements in treatment and improved prognosis for patients with primary colorectal cancer, survival and functional outcomes following surgery for colorectal spinal metastasis remain unclear. We sought to evaluate surgical outcomes in patients with metastatic colorectal spinal lesions, and to examine the influence of primary lesion location on survival.
Methods: We performed a retrospective review of patients who underwent spine surgery for metastatic colorectal cancer at a single institution from 2005 to 2011. We recorded preoperative, operative and postoperative factors; functional outcome as determined by change in Karnofsky Performance Status (KPS) and modified Rankin scale (mRS) during follow-up; and survival. We performed a univariate analysis and stratified patients into two groups based on the position of the primary cancer either proximal (i.e. colon) or distal (i.e. rectum) to the rectosigmoid junction.
Results: Fourteen consecutive patients, with a median age of 52 (48-66) years, underwent 21 spine surgeries for metastatic colorectal cancer between 2005 and 2011. Pain was the most common presenting symptom (n=11, 79%), followed by motor weakness (n=8, 57%). Twenty-seven postoperative complications occurred in 11 (52%) cases. Baseline KPS and mRS remained stable in four (29%), improved in two (14%), worsened in six (43%), and was unknown in two (14%) patients at last follow-up. Patients with spinal metastasis arising from the rectum (n=6) had a significantly longer survival compared to spinal metastasis from the colon (n=8), with a median survival of 84 (56-103) versus 26 (19-44) months after primary diagnosis (p=0.002), 19 (13-27) versus five (3-9) months after spine metastasis diagnosis (p=0.010), and six (4-14) versus three (2-4) months after surgery (p=0.030).
Conclusions: Patients with spinal metastasis arising from rectal primary lesions display longer survival compared to colon primary lesions. Consideration of these factors is essential to appropriately assess surgical candidacy.
Patient Care: This research provides surgeons with information to effectively counsel patients and determine appropriate treatment paradigms based on life expectancy for patients diagnosed with a colorectal carcinoma metastasis to the spine.
Learning Objectives: By the conclusion of this session, participants should be able to discuss surgical outcomes in patients with metastatic colorectal spinal lesions, and the influence of primary lesion location on survival.