Minimally invasive surgery of humeral metastasis using flexible nails and cement in high-risk patients with advanced cancer

Abstract

This study was conducted to evaluate the preliminary outcome of palliative minimally invasive surgery for humeral metastasis in patients who have multiple advanced cancers with short life expectancy. Percutaneous Ender nailing and direct transcortical intramedullary cementing were performed on a total of 15 patients with metastatic disease of the humerus. The origins of the cancers were the lung (n=9), breast (n=3), colon (n=2) and liver (n=1). Each patient had multiple unresectable organic metastases and proved to be at high risk for anesthesia and bloody surgery. All procedures were performed under regional anesthesia and fluoroscopic guidance. The mean amount of intramedullary cement injection after Ender nailing was 13.4ml. The mean of the numeric rating scale (NRS) score for pain decreased from 9.6 points before surgery to 3.6 points after surgery (P<0.001). The mean of the Musculoskeletal Tumor Society (MSTS) functional score increased from 10.6 points before surgery to 19.9 points after surgery (P<0.001). Seven patients died within 7 months. There were no complications associated with cement leakage, fixation failure and surgical wound even in cases of early postoperative radiation or chemotherapy. Percutaneous flexible nailing along with intramedullary cementing could be a useful minimally invasive surgical method for the palliation of humeral metastasis in selective terminal cancer patients by providing immediate reliable fixation and effective pain relief.