ABSTRACT
BACKGROUND: Cancer of the lower intestinal tract, although relatively common, rarely metastasizes to the skeleton. The treatment of metastatic bone disease due to colorectal cancer has thus been poorly described and treatment decisions are therefore difficult. The aim of this study was to describe the outcome of orthopedic surgery in patients with pathological fractures from colorectal cancer and investigate factors that correlate with patient survival, since it influences treatment decisions. METHODS: Retrospective review of data collected in a prospectively collected database. 36 patients (38 fractures) who underwent surgery between 2000 and 2019 for metastatic bone disease caused by colorectal cancer were included. RESULTS: Most metastases were localized in the axial skeleton and 33/36 patients already had visceral metastases. Patients with pathological fractures from colorectal cancer had poor prognosis, with only 5/36 surviving more than 1 year, median survival being 3 months. Patients presenting with a single skeletal metastasis had a superior overall survival (P≤0.001). Post-operative complications were common, noted in 11 patients, and the surgical failure rate was considerable. CONCLUSIONS: Although relatively rare, bone metastases should be suspected in patients with colorectal cancer presenting with signs and symptoms of spinal cord compression or skeletal pain. In this case, the presence of a solitary skeletal lesion is a favorable prognostic sign. Awareness for local complications after surgery should be high.
ABSTRACT
PURPOSE: To analyse the non-response group in the Swedish Knee Ligament Register (SKLR). METHODS: All 3588 patients in the SKLR who had undergone anterior cruciate ligament surgery in 2010 were included. Respondents (n = 1865) and non-respondents (n = 1723) at the 2-year follow-up survey were assessed for potential differences in demographics and baseline data. KOOS/EQ5D questionnaires were sent to non-respondents together with a non-response survey asking questions about reasons for dropout. RESULTS: Respondents had a significantly higher mean age (27.8 years, range 9-64) than non-respondents (25.9 years, range 12-65) (p < 0.001). Women had a higher rate of response 927 (62.8 %) than men 938 (44.4 %) even after correction for age (p < 0.001). Alpine/telemark skiing was the only activity at time of injury that showed higher rate of respondents 280 (62.5 %) compared to non-respondents 168 (37.5 %) (p < 0.001). No differences in EQ5D at 2-year follow-up were found between the groups. The change in KOOS from 0 to 2 years showed difference in the subscale pain with 9.4 in the response group compared to 6.3 in the late-response group (p < 0.05) and the subscale quality of life with a difference of 26.1 and 22.6, respectively (p < 0.05). The non-response questionnaire showed shortcomings in patient information regarding the importance of the SKLR. CONCLUSION: The register is valid concerning baseline surgical data, but higher age, female gender and perhaps higher socioeconomic status improve the response rates. KOOS showed small differences of questionable clinical significance. The SKLR patient information could be improved. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.
