96 Acta Orthopaedica 2011; 82 (1): 96–101 Surgery for skeletal metastases in lung cancer Complications and survival in 98 patients Rudiger J Weiss and Rikard Wedin Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden Correspondence: rudiger.weiss@karolinska.se Submitted 10-04-30 Accepted 10-09-17 Background and purpose Most lung cancer patients with skeletal metastases have a short survival and it is difficult to identify those patients who will benefit from palliative surgery. We report com- plication and survival rates in a consecutive series of lung cancer patients who were operated for symptomatic skeletal metastases. Methods This study was based on data recorded in the Karolinska Skeletal Metastasis Register. The study period was 1987–2006. We identified 98 lung cancer patients (52 females). The median age at surgery was 62 (34–88) years. 78 lesions were located in the femur or spine. Results The median survival time after surgery was 3 (0–127) months. The cumulative 12-month survival after surgery was 13% (95% CI: 6–20). There was a difference between the survival after spinal surgery (2 months) and after extremity surgery (4 months) (p = 0.03). Complete pathological fracture in non-spinal metastases (50 patients) was an independent negative predictor of survival (hazard ratio (HR) = 1.8, 95% CI: 1–3). 16 of 31 patients with spinal metastases experienced a considerable improvement in their neurological function after surgery. The overall complica- tion rate was 20%, including a reoperation rate of 15%. Interpretation Bone metastases and their subsequent surgical treatment in lung cancer patients are associated with high mor- bidity and mortality. Our findings will help to set appropriate expectations for these patients, their families, and surgeons.  Lung cancer has become one of the most common cancers worldwide and is the predominant cause of death among cancer patients. The American Cancer Society estimated that almost 160,000 patients would die from lung and bronchus cancer in the USA in 2009 (Jemal et al. 2009). Some authors have stated that lung cancer is one of the most important chal- lenges in oncology at the present time (Boyle and Dresler 2005). Historically, about one third of all lung cancer patients are found to have bone metastases during the course of the dis- ease. Symptoms and events of skeletal origin such as pain, pathological fractures, spinal cord compression with para- paresis, and hypercalcemia are common complications. The decline in quality of life and eventual death of these patients can be explained to some extent by skeletal complications and their treatment (Coleman 1997). Lung cancer patients with skeletal events have a short expected survival; however, some case reports have involved patients who survived several years after pathological frac- tures (Agarwala and Hanna 2005, Hirano et al. 2005). A major problem in selecting patients for surgery is to avoid operat- ing on those who are likely to die very soon after surgery. Although several features help to identify patients with long survival (Bauer and Wedin 1995, Tomita et al. 2001), it is still difficult to identify those who will die early. We analyzed a consecutive series of lung cancer patients who were operated on for skeletal metastases at our depart- ment, to determine the complications and reoperation rates after surgery and to identify risk factors for early death. Patients and methods This study was based on data recorded in the Karolinska Skel- etal Metastasis Register (Wedin and Bauer 2005). The reg- ister is a quality-control database that prospectively collects individual-based information for cancer patients admitted to Karolinska University Hospital in Stockholm. All data are col- lected based on the national registration number (a 10-digit number), which is unique for each Swedish resident. The cri- terion for inclusion in the database is surgical treatment for complete or impending fractures due to skeletal metastasis. The register gathers data on patient identity, age, sex, pri- mary tumor, location of metastases, type of pathological fracture, and surgical treatment such as method of fixation, type of implant, and postoperative complications. It includes staging information for patients diagnosed with lung cancer Open Access - This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited. DOI 10.3109/17453674.2011.552779