Acta Orthopaedica 2011; 82 (1): 96–101 99 Table 5. Reoperations after surgery for skeletal metastases in lung cancer patients Localization Primary operation Humerus, proximal Humerus, distal Acetabulum Femur, proximal Femur, proximal Femur, trochanteric Femur, trochanteric Femur, trochanteric Femur, subtrochanteric Femur, distal Vertebra, thoracic Vertebra, thoracic Vertebra, thoracic Vertebra, thoracic Intramedullary nail Plate Acetabular reinforcement ring + total joint arthroplasty Total joint arthroplasty Hemiarthroplasty Hemiarthroplasty Sliding hip screw Sliding hip screw Hemiarthroplasty Plate Decompression Decompression + instrumentation Decompression + instrumentation Decompression Time (months) to and reason for failure Treatment 5, local tumor progression 3, material failure Hemiarthroplasty Plate 1, deep infection 9, periprosthetic fracture 3, periprosthetic fracture 1, poor initial fixation 1, poor initial fixation 1, poor initial fixation 4, poor bone stock 0, technical error 13, non-union + local tumor progression 0, paraplegia (hematoma) Debridement Modular tumor prosthesis Modular tumor prosthesis Total joint arthroplasty Total joint arthroplasty Exchange of screw Total joint arthroplasty Hemiarthroplasty Plate Removal of hematoma 8, local tumor progression Decompression 0, poor initial fixation 1, deep infection Reinstrumentation Debridement a adenocarcinoma. b squamous cell carcinoma. c large cell carcinoma. d other. Table 6. Complications after surgery for skeletal metastasis in lung cancer patients Sex, age, histology F, 57, b F, 63, c F, 62, a F, 62, a F, 74, a F, 66, a M, 45, a F, 73, b F, 62, a F, 53, a M, 56, a M, 55, d F, 48, a M, 72, b Sex, age, histology F, 75, a M, 48, c F, 48, b M, 62, d M, 55, d Localization Primary operation Femur, distal Vertebra, thoracic Vertebra, thoracic Vertebra, thoracic Vertebra, thoracic Intramedullary nail Decompression + instrumentation Decompression + instrumentation Decompression + instrumentation Decompression Time (months) to and reason for failure 0, fatal gastric bleeding 0, wound infection 0, gastric bleeding 0, technical error 1, wound infection Treatment Non-surgical Non-surgical Non-surgical Non-surgical Non-surgical a adenocarcinoma. b large cell carcinoma. c small cell lung cancer. d other. Discussion Our main finding was the short survival of lung cancer patients after surgery for skeletal metastases. Complete pathological fracture was identified as an independent risk factor for death. Moreover, a high complication rate poses a considerable burden to the patients. The overall median survival time after surgery was only 3 months, and just 13% of the patients were still alive 1 year postoperatively. 3 of 4 patients were already classified as having an advanced stage of lung cancer at the diagnosis of the primary tumor. The 1-year survival rate of patients oper- ated for skeletal metastases from various primary tumor sites is limited, and ranges between 30 and 54% (Bono et al. 1991, Bauer and Wedin 1995, Durr and Refior 1998, Bohm and Huber 2002, Hansen et al. 2004, Lin et al. 2007). Differences in patient selection, type of primary tumor, and indications for surgery may explain the spread in survival time. We have pre- viously reported on the surgical outcome of 107 patients with skeletal breast cancer metastases. The postoperative median survival in these patients was 8 months (Wedin et al. 2001). Sugiura et al. (2008) reported a median survival time of 7 months in 118 patients with bone metastasis from lung cancer; however, only one third of these patients underwent surgery. Nathan et al. (2005) found that in patients with various types of cancer metastases, lung cancer patients fared the worst with a median survival time of 4 months. The short survival time has also been reported by other authors (Bauer and Wedin 1995, Durr and Refior 1998, Katagiri et al. 2005). We found a shorter survival after operations for skeletal metastases of the spine (2 months) as compared to the extrem- ities (4 months). Bauer and Wedin (1995) described a median 1-year survival of 25% after spinal surgery and 31% after extremity surgery, based on all types of cancer metastases. However, this difference was not statistically significant. The decision between a surgical and non-surgical treatment of a patient with bone metastasis is influenced by the anatomi- cal location, the tumor type, the extent of the tumor, the gen-